Provider Demographics
NPI:1518047059
Name:GOLDMAN, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
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:PO BOX 5479
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5400
Mailing Address - Country:US
Mailing Address - Phone:423-581-7177
Mailing Address - Fax:423-587-9806
Practice Address - Street 1:1415 OLD WEISGARBER RD STE 350
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1327
Practice Address - Country:US
Practice Address - Phone:865-588-1605
Practice Address - Fax:865-588-1608
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029311Medicaid
TNP00157588Medicare PIN
TNE46787Medicare UPIN
TN3821916Medicaid