Provider Demographics
NPI:1821339763
Name:MALCOLM GEORGE GOLDSMITH MD
Entity Type:Organization
Organization Name:MALCOLM GEORGE GOLDSMITH MD
Other - Org Name:MALCOLM GOLDSMITH MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-582-8102
Mailing Address - Street 1:2072 NE 121ST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3322
Mailing Address - Country:US
Mailing Address - Phone:305-582-8102
Mailing Address - Fax:
Practice Address - Street 1:1050 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5805
Practice Address - Country:US
Practice Address - Phone:305-891-8850
Practice Address - Fax:305-891-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24823261QR0400X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility