Healthcare Provider Details

I. General information

NPI: 1588821102
Provider Name (Legal Business Name): VICTORIA GOLDSMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MADISON ST
SYRACUSE NY
13210-2319
US

IV. Provider business mailing address

620 MADISON ST
SYRACUSE NY
13210-2319
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-3600
  • Fax: 315-426-3603
Mailing address:
  • Phone: 315-426-3600
  • Fax: 315-426-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number174433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: