Provider Demographics
NPI:1083047963
Name:PETER H GOLDMANN MD PC
Entity Type:Organization
Organization Name:PETER H GOLDMANN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-285-1722
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-285-1722
Mailing Address - Fax:804-285-4753
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 508
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-285-1722
Practice Address - Fax:804-285-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026380207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180042869OtherRAILROAD MEDICARE
VA180000887Medicare PIN