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NPI Code Detail

MEDICARE: DEIDRE VIAN GOLDSMITH C.R.N.A.

MEDICARE: DEIDRE VIAN GOLDSMITH C.R.N.A.
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
1367500000XCertified Registered Nurse AnesthetistR141638MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2454MH697OTHERMDTRAILBLAZER

General Provider Information

NPI Number : 1578569133
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRE VIAN GOLDSMITH C.R.N.A.
Provider Business Mailing Address
First Line : 10 SHIRECREST
Second Line :
City : AVON
State : CT
Zip : 06001-3965
Country : US
Telephone Number : 443-831-0093
Fax Number :
Provider Business Practice Location Address
First Line : 5401 OLD COURT RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-5103
Country : US
Telephone Number : 410-521-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 09/16/2009

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