Healthcare Provider Details

I. General information

NPI: 1770015703
Provider Name (Legal Business Name): BRETT RYAN GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE STE 867.2
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

375 DIXMYTH AVE STE 867.2
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-6200
  • Fax: 513-862-4358
Mailing address:
  • Phone: 513-862-6200
  • Fax: 513-862-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberT7572
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number59298
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35.150853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: