Provider Demographics
NPI:1124065768
Name:GOLDSMITH, GARY N (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-731-6888
Mailing Address - Fax:617-731-5075
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-731-6888
Practice Address - Fax:617-731-5075
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA368802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA720756OtherTUFTS PLAN PROVIDER ID
MAC26056OtherBC/BS PROVIDER ID
MA720756OtherTUFTS PLAN PROVIDER ID
C26056Medicare ID - Type Unspecified