MEDICARE: STEPHEN M. GOLDMAN MD

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	207W00000X	Ophthalmology Physician	MD036832E	PA

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	:	1982698619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN M. GOLDMAN MD

Provider Business Mailing Address
First Line	:	700 SPRUCE ST
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4022
Country	:	US
Telephone Number	:	215-829-5311
Fax Number	:	215-829-3091

Provider Business Practice Location Address
First Line	:	700 SPRUCE ST
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4022
Country	:	US
Telephone Number	:	215-829-5311
Fax Number	:	215-829-3091

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/29/2010

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