Provider Demographics
NPI:1538153077
Name:GOLDNER, WAYNE L (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:L
Last Name:GOLDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2713
Mailing Address - Country:US
Mailing Address - Phone:603-622-3162
Mailing Address - Fax:603-622-8677
Practice Address - Street 1:150 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2713
Practice Address - Country:US
Practice Address - Phone:603-622-3162
Practice Address - Fax:603-622-8677
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000080Medicaid
NH4202355OtherAETNA NON-HMO
NH0104464Y0NH01OtherANTHEM PROVIDER ID
NH2194915OtherAETNA HMO
NHE74369Medicare UPIN
NH4202355OtherAETNA NON-HMO