MEDICARE: DR. MARISSE GOLDMAN M.D.

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	207R00000X	Internal Medicine Physician	ME53404	FL

General Provider Information

NPI Number	:	1992705313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSE GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 341703
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33694-1703
Country	:	US
Telephone Number	:	813-690-2003
Fax Number	:	813-264-6929

Provider Business Practice Location Address
First Line	:	3304 WESTMORELAND DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2156
Country	:	US
Telephone Number	:	813-690-2003
Fax Number	:	813-264-6929

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/30/2014

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