Provider Demographics
NPI:1730170994
Name:GOLDSMITH, IAN LANCE (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:LANCE
Last Name:GOLDSMITH
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 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:3RD FLOOR SUITE C&D
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:413-794-5600
Practice Address - Fax:413-794-7297
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2370842084N0400X, 2084N0400X
FLME1000302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101645303Medicaid
TX130026149Medicare PIN
TX101645302Medicaid
TX101645301Medicaid
TXTXB126908Medicare PIN
TX130024027Medicare PIN
TX130023952Medicare PIN
FLCP560ZMedicare PIN
G18976Medicare UPIN
FL001473000Medicaid
86963KMedicare PIN
8103K2Medicare PIN
82055KMedicare PIN
TXTXB126882Medicare PIN