Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 56197 | CT |
N | 208000000X | Pediatrician | 56197 | CT |
NPI | 1649597279 |
---|---|
Provider Name | Dr. Michael Paul Goldman |
First Address | New Haven, CT 06511 |
Second Address | New Haven, CT 06511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 17/03/2018 |