=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215086426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELENE GOLDSMAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 J CLYDE MORRIS BLVD ANNEX 2ND FLOOR PENINSULA PULMONARY ASSOCIATES
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-594-2732
-----------------------------------------------------
Fax | 757-594-3824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 PAMUNKEY TURN
-----------------------------------------------------
City | YORKTOWN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23693-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-865-0517
-----------------------------------------------------
Fax | 757-865-3824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101042746
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------