Healthcare Provider Details

I. General information

NPI: 1316950991
Provider Name (Legal Business Name): RICHARD JEFFREY GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST DUAL DIAGNOSIS SERVICES
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST DUAL DIAGNOSIS SERVICES
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-487-6046
Mailing address:
  • Phone: 513-861-3100
  • Fax: 513-487-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35-045092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: