Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 42519 | MA |
N | 111NI0900X | Internist | 42519 | MA |
Y | 207RG0100X | Gastroenterologist | 42519 | MA |
NPI | 1003889726 |
---|---|
Provider Name | Dr. Marc A Goldman |
First Address | Springfield, MA 01104-2391 |
Second Address | Springfield, MA 01104-2391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003117505 | (05) | CT |
110037496/A | (05) | MA |
B77042 | (02) | MA |