Provider Demographics
NPI:1417950767
Name:GOLDMAN, DANIEL MARC (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARC
Last Name:GOLDMAN
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 1:210 YORKTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:215-600-4590
Mailing Address - Fax:
Practice Address - Street 1:1040 KINGS HWY N STE 104
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1925
Practice Address - Country:US
Practice Address - Phone:856-528-4323
Practice Address - Fax:856-888-7078
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061900L207R00000X
NJ25MA07546700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5368570OtherAETNA
PA0016719030011Medicaid
PA146134OtherHIGHMARK
PA0016719030011Medicaid