Provider Demographics
NPI:1801073754
Name:HOWARD I GOLDMAN, MD LLC
Entity type:Organization
Organization Name:HOWARD I GOLDMAN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/ CREDENTIALS
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-7999
Mailing Address - Street 1:9106 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4329
Mailing Address - Country:US
Mailing Address - Phone:410-238-3262
Mailing Address - Fax:410-238-3265
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-238-3262
Practice Address - Fax:410-238-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty