Healthcare Provider Details

I. General information

NPI: 1801828785
Provider Name (Legal Business Name): DEBORAH ANN GOLDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5378
  • Fax: 216-444-2974
Mailing address:
  • Phone: 216-444-5378
  • Fax: 216-444-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34001
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number34001
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number242583
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number128049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: