=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932143757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD H GOLDSMITH DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 03/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 MILL CREEK RD # H1N
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19003-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-529-7505
-----------------------------------------------------
Fax | 610-482-9393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 212
-----------------------------------------------------
City | HAVERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19041-0212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-529-7505
-----------------------------------------------------
Fax | 610-529-7505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | SC002437L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------