Provider Demographics
NPI:1164474441
Name:GOLDMAN, PHILIP MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARK
Last Name:GOLDMAN
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 1:7649 PLOW SHARE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8067
Mailing Address - Country:US
Mailing Address - Phone:513-368-6989
Mailing Address - Fax:859-918-5085
Practice Address - Street 1:7649 PLOW SHARE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8067
Practice Address - Country:US
Practice Address - Phone:513-368-6989
Practice Address - Fax:859-918-5085
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060870207P00000X
ALMD44827207P00000X
KY32101207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGO0859606Medicare ID - Type Unspecified
OHF28338Medicare UPIN