Provider Demographics
NPI:1144266214
Name:HOWARD M. GOLDMAN, D.O.
Entity type:Organization
Organization Name:HOWARD M. GOLDMAN, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-677-1155
Mailing Address - Street 1:10159 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3613
Mailing Address - Country:US
Mailing Address - Phone:215-677-1155
Mailing Address - Fax:215-677-5424
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005913L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019122750003Medicaid
PA0177910000OtherINDEPENDENCE BLUE CROSS
PA3008629OtherAETNA
PA374927OtherHIGHMARK BLUE SHIELD
E56442Medicare UPIN
PA3008629OtherAETNA