Provider Demographics
NPI:1891987202
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:BENJAMIN GOLDMAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR FINANCE BUSINESS OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8224
Mailing Address - Fax:330-665-8321
Practice Address - Street 1:71 BAKER BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3639
Practice Address - Country:US
Practice Address - Phone:330-836-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty