Provider Demographics
NPI:1801828785
Name:GOLDMAN, DEBORAH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
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 1:9500 EUCLID AVE # R3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-5378
Mailing Address - Fax:216-444-2974
Practice Address - Street 1:9500 EUCLID AVE # R3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-5378
Practice Address - Fax:216-444-2974
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34001208000000X, 2080P0206X
NY2425832080P0206X
OH1280492080T0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7777470Medicaid
MN01T97GROtherBCBS
MN29-13389OtherMEDICA CHOICE
MN546518400Medicaid
MNHP21981OtherHEALTHPARTNERS
NY03613141Medicaid
MN1000791OtherPREFERRED ONE
MN105091OtherUCARE
WI31989400Medicaid
MN644605OtherARAZ
MT0052207Medicaid
ND10387Medicaid
MN29-72575OtherMEDICA PRIMARY
SD7777470Medicaid