Provider Demographics
NPI:1326035395
Name:GOLDMAN, EILEEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:K
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1538
Mailing Address - Country:US
Mailing Address - Phone:330-666-3400
Mailing Address - Fax:330-665-5133
Practice Address - Street 1:3535 GRANGER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1538
Practice Address - Country:US
Practice Address - Phone:330-666-3400
Practice Address - Fax:330-665-5133
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000028650OtherANTHEM
OH0675523Medicaid
OH407OtherSUMMA
OHGO0530234Medicare PIN
OHD31322Medicare UPIN
OH0675523Medicaid