Provider Demographics
NPI:1316984958
Name:GOLDMAN, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:GOLDMAN
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:DEPT LA 21559
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1559
Mailing Address - Country:US
Mailing Address - Phone:323-297-0670
Mailing Address - Fax:
Practice Address - Street 1:2202 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5706
Practice Address - Country:US
Practice Address - Phone:310-264-9000
Practice Address - Fax:310-264-9004
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG379542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G379540Medicaid
CA00G379540OtherBLUE SHIELD OF CA
CAWG37954GMedicare PIN
CAP00306614Medicare PIN
CA00G379540Medicaid
CAWG37954HMedicare PIN
CA00G379540OtherBLUE SHIELD OF CA
CAWG37954JMedicare PIN
CAWG37954EMedicare PIN