MEDICARE: DR. NOAH JAN GOLDMAN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC002177L	PA

General Provider Information

NPI Number	:	1013985100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOAH JAN GOLDMAN DPM

Provider Business Mailing Address
First Line	:	7919 VERREE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2526
Country	:	US
Telephone Number	:	215-742-8383
Fax Number	:

Provider Business Practice Location Address
First Line	:	7919 VERREE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2526
Country	:	US
Telephone Number	:	215-742-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/27/2007

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