Provider Demographics
NPI:1760455778
Name:GOLDER, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:GOLDER
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 1:600 N BRAND BLVD STE 640
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4215
Mailing Address - Country:US
Mailing Address - Phone:213-814-0040
Mailing Address - Fax:917-338-1381
Practice Address - Street 1:600 N BRAND BLVD STE 640
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4215
Practice Address - Country:US
Practice Address - Phone:213-814-0040
Practice Address - Fax:917-338-1381
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2680822084P0800X
CAG1410462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010123593Medicaid
MD406720700Medicaid
DC036575900Medicaid
DC015893M83Medicare ID - Type Unspecified
MD406720700Medicaid
CACB267148Medicare PIN