Provider Demographics
NPI:1235441957
Name:GOLDMAN, MARINA D (NP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:D
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:D
Other - Last Name:MAHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:395 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-584-7787
Mailing Address - Fax:413-584-7778
Practice Address - Street 1:395 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-7787
Practice Address - Fax:413-584-7778
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0067831363LX0001X
MARN186337363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT026-0067831OtherLICENSE