Provider Demographics
NPI:1073543930
Name:GOLDMAN, MICHAEL ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4727
Mailing Address - Country:US
Mailing Address - Phone:434-295-9153
Mailing Address - Fax:434-295-9154
Practice Address - Street 1:417 8TH ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4727
Practice Address - Country:US
Practice Address - Phone:434-295-9153
Practice Address - Fax:434-295-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000810213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP 11018063OtherMULTIPLAN
VA063036OtherBCBS OF VIRGINIA
VA009320288Medicaid
VA480000221Medicare ID - Type Unspecified
VA009320288Medicaid