Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC8636 | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC8636 | PA |
NPI | 1154329118 |
---|---|
Provider Name | Mr. Harlan Matthew Goldman |
First Address | Wexford, PA 15090 |
Second Address | Cranberry Twp, PA 16066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 11/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11183316 | CAQH (01) | PA |
2150317 | FIRST HEALTH (01) | PA |
30299 | UMPC (01) | PA |
7503594 | AETNA (01) | PA |
86880 | (02) | PA |
GO1310247 | BCBS (01) | PA |