Provider Demographics
NPI:1013452457
Name:GOLDMAN, CARLEY ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:ERIN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1123
Mailing Address - Country:US
Mailing Address - Phone:267-574-8106
Mailing Address - Fax:267-574-8111
Practice Address - Street 1:339 E STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7711
Practice Address - Country:US
Practice Address - Phone:215-464-4111
Practice Address - Fax:267-574-8111
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058799363AM0700X
PAOA004025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA561497YEBKMedicare PIN
PA561496YUNMMedicare PIN