Provider Demographics
NPI:1225019169
Name:GOLDMAN, SAMUEL J (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2512
Mailing Address - Country:US
Mailing Address - Phone:603-663-7030
Mailing Address - Fax:603-663-7039
Practice Address - Street 1:138 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2512
Practice Address - Country:US
Practice Address - Phone:603-663-7030
Practice Address - Fax:603-663-7039
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11562207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH011562OtherTUFTS PIN
NH2864160OtherAETNA PIN
NH30222124Medicaid
NH579605OtherCIGNA PIN
NH0406289OtherUHC PIN
NH692523OtherHPHC PIN
NHO4YP03808NH01OtherANTHEM ACES PIN
NHH60241OtherANTHEM REFERRING UPIN
NH0406289OtherUHC PIN
NH2864160OtherAETNA PIN