Healthcare Provider Details

I. General information

NPI: 1780681981
Provider Name (Legal Business Name): JAMES A GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 INDEPENDENCE DR
CHESTNUT HILL MA
02467-3628
US

IV. Provider business mailing address

291 INDEPENDENCE DR
CHESTNUT HILL MA
02467-3628
US

V. Phone/Fax

Practice location:
  • Phone: 617-541-6675
  • Fax: 617-541-7505
Mailing address:
  • Phone: 617-541-6675
  • Fax: 617-541-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number49314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: