Provider Demographics
NPI:1629009352
Name:GOLDGEIER, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GOLDGEIER
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 1:919 WESTFALL RD
Mailing Address - Street 2:BLDG A. SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2638
Mailing Address - Country:US
Mailing Address - Phone:585-244-4240
Mailing Address - Fax:585-442-4767
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG A. SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2638
Practice Address - Country:US
Practice Address - Phone:585-244-4240
Practice Address - Fax:585-442-4767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY148706207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010148706OtherEXCELLUS HMO
NYAA0971OtherRAILROAD MEDICARE PIN
NY1016OtherEXCELLUS BLUE SHIELD
NYMD4F31OtherPREFERRED CARE
NY010148706OtherEXCELLUS HMO
NYMD4F31OtherPREFERRED CARE