Provider Demographics
NPI:1144214818
Name:GOYAL, ANUJ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
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 1:9001 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1175
Mailing Address - Country:US
Mailing Address - Phone:937-832-0990
Mailing Address - Fax:937-832-7323
Practice Address - Street 1:9001 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1175
Practice Address - Country:US
Practice Address - Phone:937-832-0990
Practice Address - Fax:937-832-7323
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-07-1194G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2090982Medicaid
OHGO0863222Medicare ID - Type Unspecified
OH2090982Medicaid