Provider Demographics
NPI:1003889726
Name:GOLDMAN, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:GOLDMAN
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 1:175 CAREW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2391
Mailing Address - Country:US
Mailing Address - Phone:413-732-4269
Mailing Address - Fax:413-785-4619
Practice Address - Street 1:175 CAREW ST STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2391
Practice Address - Country:US
Practice Address - Phone:413-732-4269
Practice Address - Fax:413-785-4619
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42519207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110037496/AMedicaid
CT003117505Medicaid
CT003117505Medicaid
CT003117505Medicaid
MAB77042Medicare UPIN
MA110037496/AMedicaid
110183535Medicare PIN