Provider Demographics
NPI:1972718179
Name:GOLDMAN, TRACY E (DO)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:E
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 E AURORA RD
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1947
Mailing Address - Country:US
Mailing Address - Phone:330-468-3312
Mailing Address - Fax:330-468-0602
Practice Address - Street 1:828 E AURORA RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1947
Practice Address - Country:US
Practice Address - Phone:330-468-3312
Practice Address - Fax:330-468-0602
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3037949Medicaid