MEDICARE: DR. LEONARD GOLDSCHMIDT J.D., PSY.D.

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	103G00000X	Clinical Neuropsychologist	845	SC

General Provider Information

NPI Number	:	1336364892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD GOLDSCHMIDT J.D., PSY.D.

Provider Business Mailing Address
First Line	:	4882 SOCASTEE BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7245
Country	:	US
Telephone Number	:	843-294-4500
Fax Number	:	843-294-4503

Provider Business Practice Location Address
First Line	:	4882 SOCASTEE BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7245
Country	:	US
Telephone Number	:	843-294-4500
Fax Number	:	843-294-4503

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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