Provider Demographics
NPI:1255456299
Name:EDWARD J. GOLDMAN, M.D.,P.A.
Entity type:Organization
Organization Name:EDWARD J. GOLDMAN, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-394-6400
Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5439
Mailing Address - Country:US
Mailing Address - Phone:443-394-6400
Mailing Address - Fax:443-394-9850
Practice Address - Street 1:25 CROSSROADS DRIVE
Practice Address - Street 2:SUITE 412
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5439
Practice Address - Country:US
Practice Address - Phone:443-394-6400
Practice Address - Fax:443-394-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD76229174400000X
MDD30288207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD760010100Medicaid
MD760010100MDMedicaid
MDKA47OtherCAREFIRST
MD760010100MDMedicaid
MD482LMedicare PIN