MEDICARE: BETH A 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	207Q00000X	Family Medicine Physician	238360	NY
2	207Q00000X	Family Medicine Physician	14913	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1932225695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A GOLDMAN M.D.

Provider Business Mailing Address
First Line	:	2510 WIGWAM PKWY STE 106
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7115
Country	:	US
Telephone Number	:	702-268-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 WIGWAM PKWY STE 106
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7115
Country	:	US
Telephone Number	:	702-268-9001
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/30/2022

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