=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144266214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD M. GOLDMAN, D.O.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10159 VERREE RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19116-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-677-1155
-----------------------------------------------------
Fax | 215-677-5424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10159 VERREE RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19116-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-677-1155
-----------------------------------------------------
Fax | 215-677-5424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOWARD M GOLDMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-677-1155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | OS005913L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------