Healthcare Provider Details

I. General information

NPI: 1972555480
Provider Name (Legal Business Name): DONALD PETER GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ERIE AVE AT FRONT ST. ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
PHILADELPHIA PA
19134-1095
US

IV. Provider business mailing address

152 HIGHLAND AVE
JENKINTOWN PA
19046-3106
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5051
  • Fax: 215-427-6693
Mailing address:
  • Phone: 215-887-0215
  • Fax: 215-887-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberMD011991E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: