Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 000340 | CT |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 238085 | MA |
N | 207Q00000X | Family Doctor | 000340 | CT |
NPI | 1629114376 |
---|---|
Provider Name | Dr. Andrew Michael Goldman |
First Address | Great Barrington, MA 01230-8901 |
Second Address | Sharon, CT 06069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 06/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49262 | (02) |