Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103000810 | VA |
Y | 222Z00000X | Podiatrist | 0103000810 | VA |
NPI | 1073543930 |
---|---|
Provider Name | Michael Alan Goldman |
First Address | Charlottesville, VA 22902-4727 |
Second Address | Charlottesville, VA 22902-4727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 20/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009320288 | (05) | VA |
063036 | BCBS OF VIRGINIA (01) | VA |
P 11018063 | MULTIPLAN (01) | VA |
T29500 | (02) |