Provider Demographics
NPI:1326570722
Name:GOLTZMAN, MICHAEL EMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMANUEL
Last Name:GOLTZMAN
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 1:19 WOODLAND ST STE 23
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2368
Mailing Address - Country:US
Mailing Address - Phone:860-522-2251
Mailing Address - Fax:860-493-2552
Practice Address - Street 1:19 WOODLAND ST STE 23
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2368
Practice Address - Country:US
Practice Address - Phone:860-522-2251
Practice Address - Fax:860-493-2552
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69944208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program