Provider Demographics
NPI:1831142926
Name:GOLDMAN, STANLEY A (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
Last Name:GOLDMAN
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 1:5855 BREMO RD
Mailing Address - Street 2:STE 403
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-288-3079
Mailing Address - Fax:804-282-6159
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:STE 403
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-288-3079
Practice Address - Fax:804-282-6159
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6000991Medicaid
VAC06778OtherGROUP PTAN
061951765Medicare ID - Type Unspecified
VA6000991Medicaid