Healthcare Provider Details

I. General information

NPI: 1205450004
Provider Name (Legal Business Name): BRYAN ALEXANDER GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 GASKINS RD
HENRICO VA
23233-1441
US

IV. Provider business mailing address

VCUHS GMEA BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-217-6363
  • Fax: 804-217-6400
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number0101281058
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: