Healthcare Provider Details

I. General information

NPI: 1598299885
Provider Name (Legal Business Name): CHLOE C. GOLDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON ROAD S. 510
MIAMI BEACH FL
33140-2840
US

IV. Provider business mailing address

4308 ALTON ROAD S. 510
MIAMI BEACH FL
33140-2840
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-8865
  • Fax:
Mailing address:
  • Phone: 305-674-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME150349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: