Provider Demographics
NPI:1629114376
Name:GOLDMAN, ANDREW MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-8901
Mailing Address - Country:US
Mailing Address - Phone:860-364-5990
Mailing Address - Fax:860-364-1366
Practice Address - Street 1:106 UPPER MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069
Practice Address - Country:US
Practice Address - Phone:860-364-5990
Practice Address - Fax:860-364-1366
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000340207Q00000X, 204D00000X
MA238085204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F49262Medicare UPIN