Provider Demographics
NPI:1477564847
Name:GOLDMAN, MARY G (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:G
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2217
Mailing Address - Country:US
Mailing Address - Phone:248-338-5516
Mailing Address - Fax:248-338-5547
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2217
Practice Address - Country:US
Practice Address - Phone:248-338-5516
Practice Address - Fax:248-338-5547
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF29839Medicare UPIN