Provider Demographics
NPI:1659471530
Name:GOLDMAN, MARGO P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGO
Middle Name:P
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3850
Mailing Address - Country:US
Mailing Address - Phone:978-474-8070
Mailing Address - Fax:978-474-8070
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3850
Practice Address - Country:US
Practice Address - Phone:978-474-8070
Practice Address - Fax:978-474-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA453412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB31119Medicare ID - Type Unspecified