Healthcare Provider Details

I. General information

NPI: 1023385374
Provider Name (Legal Business Name): DR MICHAEL H GOLDMAN MD FACC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 150
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR SUITE 150
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-5556
  • Fax: 703-807-0082
Mailing address:
  • Phone: 703-698-5556
  • Fax: 703-807-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101043150
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL GOLDMAN
Title or Position: OWNER
Credential: MD
Phone: 703-698-5556