Provider Demographics
NPI:1336128107
Name:GOLDMAN, SALUJA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SALUJA
Middle Name:R
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALUJA
Other - Middle Name:R
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:601 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-625-9575
Mailing Address - Fax:561-625-9533
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2788
Practice Address - Country:US
Practice Address - Phone:561-625-9575
Practice Address - Fax:561-625-9533
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86718207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
820556723OtherCIGNA HEALTHCARE
820556723OtherPRIVATE HEALTHCARE SYSTEM
12302684OtherMULTI PLAN
FL57772OtherBCBS
7302508OtherAETNA
820556723OtherUNITED HEALTHCARE
P2775296OtherOXFORD HEALTH
FL21231237688OtherBEECH STREET
FL266709600Medicaid
P00083413OtherPALMETTO MC
015061OtherALL PPO
11306611OtherCAQH
820556723OtherHUMANA PPO
9950OtherDIMENSION HEALTH
11306611OtherCAQH
7302508OtherAETNA