Provider Demographics
NPI:1992782734
Name:GOOLMAN, HAL BRADLEY (DPM)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:BRADLEY
Last Name:GOOLMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 CLOVER LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598
Mailing Address - Country:US
Mailing Address - Phone:603-788-2521
Mailing Address - Fax:603-788-5027
Practice Address - Street 1:8 CLOVER LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598
Practice Address - Country:US
Practice Address - Phone:603-788-2521
Practice Address - Fax:603-788-5027
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0245213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTORE1597Medicaid
NH30362449Medicaid
NH30362449Medicaid
NHT93578Medicare UPIN