Provider Demographics
NPI:1104828300
Name:GOYAL, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:GOYAL
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 1:1530 NEEDMORE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3969
Mailing Address - Country:US
Mailing Address - Phone:937-277-4274
Mailing Address - Fax:937-277-8476
Practice Address - Street 1:1530 NEEDMORE RD
Practice Address - Street 2:STE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3969
Practice Address - Country:US
Practice Address - Phone:937-277-4274
Practice Address - Fax:937-277-8476
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-3153174400000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0857381Medicaid
OHGO0716321Medicare ID - Type Unspecified
OHH065100Medicare PIN
OH0857381Medicaid