Provider Demographics
NPI:1316074404
Name:GOLDMAN, AVIVA B (MD)
Entity type:Individual
Prefix:
First Name:AVIVA
Middle Name:B
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:MEYER 144
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:410-955-2240
Mailing Address - Fax:410-955-5795
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MEYER 144
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-2240
Practice Address - Fax:410-955-5795
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2397012084P0800X
MDD00715552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry