MEDICARE: DEBORAH K GOLDMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	01028975	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000579110	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942275888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH K GOLDMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 359
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47703-0359
Country	:	US
Telephone Number	:	812-485-1220
Fax Number	:	812-485-8544

Provider Business Practice Location Address
First Line	:	3900 WASHINGTON AVE
Second Line	:	STE 100A
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0550
Country	:	US
Telephone Number	:	812-485-7240
Fax Number	:	812-485-7244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/14/2012

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