Provider Demographics
NPI:1699764175
Name:GOLDMAN, HOWARD MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MICHAEL
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:10159 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3613
Practice Address - Country:US
Practice Address - Phone:215-677-1155
Practice Address - Fax:215-677-5424
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005913L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001253823Medicaid
PA421377V4CMedicare PIN
PAP00471549Medicare PIN
PA001253823Medicaid