Provider Demographics
NPI:1306811377
Name:GOLDMAN, CHARLES J (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:229 W BUTE ST
Mailing Address - Street 2:STE 500
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:757-388-1063
Mailing Address - Fax:757-388-1022
Practice Address - Street 1:229 W BUTE ST
Practice Address - Street 2:STE 500
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-388-1063
Practice Address - Fax:757-388-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006025986Medicaid
VA006025986Medicaid
110005525Medicare ID - Type Unspecified