Healthcare Provider Details

I. General information

NPI: 1629060504
Provider Name (Legal Business Name): MICHAEL H GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 620
FAIRFAX VA
22031-5204
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 620
FAIRFAX VA
22031-5204
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:
Title or Position:
Credential:
Phone: