Provider Demographics
NPI:1386747632
Name:GOLDMAN, SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
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 1:8208 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1757
Mailing Address - Country:US
Mailing Address - Phone:505-858-1222
Mailing Address - Fax:505-858-1224
Practice Address - Street 1:8208 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1757
Practice Address - Country:US
Practice Address - Phone:505-858-1222
Practice Address - Fax:505-858-1224
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-53207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15566Medicaid
NM404667YNMTMedicare PIN
NM15566Medicaid
343730202Medicare PIN