Healthcare Provider Details

I. General information

NPI: 1639672181
Provider Name (Legal Business Name): GOLDMAN MEDICAL P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 KENTMERE LANE
ASHEVILLE NC
28803
US

IV. Provider business mailing address

1516 KENTMERE LANE
ASHEVILLE NC
28803
US

V. Phone/Fax

Practice location:
  • Phone: 828-782-3317
  • Fax: 828-412-0293
Mailing address:
  • Phone: 828-782-3317
  • Fax: 828-412-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2010-00606
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2011-01897
License Number StateNC

VIII. Authorized Official

Name: SIGNI GOLDMAN
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 828-782-3317