Provider Demographics
NPI:1215466719
Name:GOLDMINZ, JACQUELINE GREB (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:GREB
Last Name:GOLDMINZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ERICA
Other - Last Name:GREB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 GREENWICH PARK
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3003
Mailing Address - Country:US
Mailing Address - Phone:781-248-6837
Mailing Address - Fax:781-369-9737
Practice Address - Street 1:20 WILLIAM ST STE G15
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-4102
Practice Address - Country:US
Practice Address - Phone:781-591-4234
Practice Address - Fax:781-369-9737
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA286388207N00000X
MA271368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA286388OtherMA LICENSE