Basic Information
| Provider Information | |||||||||
| NPI: | 1528058070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDING | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 7595 ANAGRAM DR | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10128 | RI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 66360 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 003118404 | 01 | CT MED ASSISTANCE | OTHER | 1600025 | 01 | UNITEDHEALTHPLANS | OTHER | 300101938 | 01 | RAILROADMEDICARE | OTHER | 7007228 | 01 | RIMEDICALASSISTANCE | OTHER | 010128 | 01 | BLUESHIELD | OTHER | 3205118 | 01 | MASSMEDICAID | OTHER | 720087501 | 01 | CIGNA | OTHER | 000000001988 | 01 | NHPRI | OTHER | 007007236 | 01 | HOSPITALPIN | OTHER | 405086 | 01 | BLUECHIP | OTHER | 101280 | 01 | TUFTS | OTHER | 3205118 | 01 | HEALTHYSTART | OTHER |