{
"Npi": {
"NPI": "1477940922",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOLDEN",
"FirstName": "MICHAEL",
"MiddleName": "LESLIE",
"NamePrefix": "DR.",
"NameSuffix": "III",
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "912 SOMERSET BLVD STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLES TOWN",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25414-3953",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-725-2663",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "912 SOMERSET BLVD STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLES TOWN",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25414",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-725-2663",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/22/2015",
"LastUpdateDate": "08/23/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "210048",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207XX0005X",
"TaxonomyName": "Sports Medicine (Orthopaedic Surgery) Physician",
"LicenseNumber": "11725386-1205",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207XX0005X",
"TaxonomyName": "Sports Medicine (Orthopaedic Surgery) Physician",
"LicenseNumber": "30403",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}