Healthcare Provider Details

I. General information

NPI: 1164578068
Provider Name (Legal Business Name): THOMAS C GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT SUITE 201
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-8263
  • Fax: 301-682-5326
Mailing address:
  • Phone: 410-938-3464
  • Fax: 410-938-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0008605
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: