Provider Demographics
NPI:1023022639
Name:GOLDMAN, MARCUS JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:JACOB
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 1:138 PEAKHAM RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2916
Mailing Address - Country:US
Mailing Address - Phone:978-808-7533
Mailing Address - Fax:
Practice Address - Street 1:138 PEAKHAM RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2916
Practice Address - Country:US
Practice Address - Phone:978-808-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA591222084F0202X, 2084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3094511Medicaid
MAJ12267OtherBLUE SHIELD
MA765922OtherTUFTS
MA26793OtherHEALTHNET
MAJ12267Medicare PIN
MAJ12267OtherBLUE SHIELD
MA26793OtherHEALTHNET