Healthcare Provider Details

I. General information

NPI: 1104828300
Provider Name (Legal Business Name): AMIT GOYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 NEEDMORE RD STE 300
DAYTON OH
45414-3969
US

IV. Provider business mailing address

1530 NEEDMORE RD STE 300
DAYTON OH
45414-3969
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-4274
  • Fax: 937-277-8476
Mailing address:
  • Phone: 937-277-4274
  • Fax: 937-277-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-06-3153
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35-06-3153
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-06-3153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: