MEDICARE: DANIEL MARC GOLDMAN M.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	207R00000X	Internal Medicine Physician	MD061900L	PA
2	207R00000X	Internal Medicine Physician	25MA07546700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5368570	OTHER	PA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	146134	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1417950767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MARC GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	210 YORKTOWN PLZ
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1424
Country	:	US
Telephone Number	:	215-600-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 KINGS HWY N STE 104
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1925
Country	:	US
Telephone Number	:	856-528-4323
Fax Number	:	856-888-7078

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/29/2023

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