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NPI Code Detail

MEDICARE: DR. DEENA SARA GOLDWATER M.D., PH.D

MEDICARE: DR. DEENA SARA GOLDWATER M.D., PH.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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RC0000XCardiovascular Disease PhysicianA143381CA
3207RG0300XGeriatric Medicine (Internal Medicine) PhysicianA143381CA

General Provider Information

NPI Number : 1962726869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEENA SARA GOLDWATER M.D., PH.D
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number :
Provider Business Practice Location Address
First Line : 880 SW 145TH AVE STE 202
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33027-6171
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2010
Last Update Date : 06/17/2026

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