Provider Demographics
NPI:1558366633
Name:GOLDING, MARTIN I (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:I
Last Name:GOLDING
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 1:1643 NW 136TH AVE BLDG H
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:954-377-2939
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:700 MARVEL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1740
Practice Address - Country:US
Practice Address - Phone:954-377-2939
Practice Address - Fax:865-560-7110
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35229207RG0100X
DEC10024864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD35229OtherSTATE LICENSE
DCD93607Medicare UPIN
DC142327D55Medicare PIN