MEDICARE: MARK GOLDIN

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	207P00000X	Emergency Medicine Physician	G48132	CA

General Provider Information

NPI Number	:	1205834751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GOLDIN

Provider Business Mailing Address
First Line	:	2032 DRAKE DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2609
Country	:	US
Telephone Number	:	510-499-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2032 DRAKE DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2609
Country	:	US
Telephone Number	:	510-339-7132
Fax Number	:

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	09/21/2010

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