Provider Demographics
NPI:1588694913
Name:GOLDMAN, MITCHELL H (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:H
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HIGHWAY
Mailing Address - Street 2:BOX U-11
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-305-9244
Mailing Address - Fax:865-305-6958
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-305-9244
Practice Address - Fax:865-305-6958
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN00158712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4283816OtherAETNA
TN770001816OtherRAILROAD MEDICARE
TN0040018OtherBLUECROSS BLUESHIELD
TN3010389Medicaid
TN621301039OtherCHAMPUS TRICARE
TN770001816OtherRAILROAD MEDICARE
TN3010389Medicaid