Provider Demographics
NPI:1134329055
Name:MAURY A GOLDMAN MD PC
Entity Type:Organization
Organization Name:MAURY A GOLDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:781-662-6010
Mailing Address - Street 1:50 ROWE ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3201
Mailing Address - Country:US
Mailing Address - Phone:781-662-6010
Mailing Address - Fax:
Practice Address - Street 1:50 ROWE ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3201
Practice Address - Country:US
Practice Address - Phone:781-662-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29767207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB31086OtherBLUE SHIELD
MA029767OtherTUFTS
MA2091674Medicaid
MA029767OtherTUFTS