Healthcare Provider Details

I. General information

NPI: 1003854985
Provider Name (Legal Business Name): MICHAEL GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL PL RADIOLOGY DEPT
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

PO BOX 64075
BALTIMORE MD
21264-4075
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9266
  • Fax: 410-545-4255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0055527
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberD0055527
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberD0055527
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: