Provider Demographics
NPI:1720278427
Name:GOLDMAN, MEIDAD BARUCH (MD)
Entity Type:Individual
Prefix:
First Name:MEIDAD
Middle Name:BARUCH
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 1:1516 KENTMERE LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2470
Mailing Address - Country:US
Mailing Address - Phone:828-575-4065
Mailing Address - Fax:
Practice Address - Street 1:1516 KENTMERE LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2470
Practice Address - Country:US
Practice Address - Phone:828-575-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00606207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2870335Medicaid
WV3810015989Medicaid
PA130608NJRMedicare PIN
PA102185220Medicaid
PA130608GXFMedicare PIN
PA1021852200001Medicaid