Provider Demographics
NPI:1669012464
Name:GOLDSMITH, ELIJAH C (LHIS)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:C
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 JOHNSON AVE STE 4N
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1063
Mailing Address - Country:US
Mailing Address - Phone:304-842-3050
Mailing Address - Fax:
Practice Address - Street 1:1400 JOHNSON AVE STE 4N
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1063
Practice Address - Country:US
Practice Address - Phone:304-842-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1087237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist