Provider Demographics
NPI:1811948987
Name:GOLDNER, JOSHUA D (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:GOLDNER
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 1:307 W MAIN ST
Mailing Address - Street 2:STE. C
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2400
Mailing Address - Country:US
Mailing Address - Phone:330-677-3628
Mailing Address - Fax:330-677-3626
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:STE. C
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2400
Practice Address - Country:US
Practice Address - Phone:330-677-3628
Practice Address - Fax:330-677-3626
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085455207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH7575756OtherAETNA
OH2596865Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
I30553Medicare UPIN
OH2596865Medicaid
OHGO4159263Medicare PIN
OHGO4159261Medicare PIN
OH11552062OtherCAQH
OH363565OtherWELLCARE MEDICAID
OH000000209941OtherUNISON
OH2596865Medicaid