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General NPI Number Information
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NPI Number | 1598760969
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Entity Type | Individual
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Provider Name | ERIC A GOULDER MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 400 MATTHEW ST STE 302
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City | MARIETTA
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State | OH
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Zip | 45750-1644
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Country | US
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Telephone | 740-568-5207
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Fax | 740-568-5297
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Provider Business Mailing Address
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Address Line | 8989 FILIZ LN
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City | POWELL
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State | OH
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Zip | 43065-9045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35041792
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License Number State | OH
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