Provider Demographics
NPI:1629060504
Name:GOLDMAN, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
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 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:STE 620
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5204
Mailing Address - Country:US
Mailing Address - Phone:703-698-5556
Mailing Address - Fax:703-807-0082
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:STE 620
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5204
Practice Address - Country:US
Practice Address - Phone:703-698-5556
Practice Address - Fax:703-807-0082
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043150207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1825253OtherPHCS (PPO)
VA54-1825253OtherTRICARE
VA1144OtherCAREFIRST BCBS (VA/DC)
VA54-1825253OtherGREAT WEST (PPO)
VA832968OtherFIRST HEALTH (PPO)
VA010245001Medicaid
VA428799OtherNCPPO (PPO)
VI428799OtherUNITED HEALTHCARE/MAMSI
VA6389467OtherCIGNA PPO
VA473766OtherAETNA US HEALTHCARE PPO
VA54-1825253OtherCCN/FIRST HEALTH (PPO)
VA54-1825253OtherUNITED HEALTHCARE HMO PPO
VA4012492OtherAETNA (HMO/POS)
MD523626-01OtherCAREFIRST BCBS (MD)
VA203593OtherANTHEM BCBS PPO/HLTH HMO
VA54-1825253OtherCCN/FIRST HEALTH (PPO)
VA54-1825253OtherPHCS (PPO)
VA3811004430Medicare ID - Type UnspecifiedMEDICAID W VA/UNISYS
VA54-1825253OtherUNITED HEALTHCARE HMO PPO
VAP00169078Medicare ID - Type UnspecifiedMEDICARE RAILROAD