Basic Information
| Provider Information | |||||||||
| NPI: | 1730229907 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRED M GOLDMAN MD INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 BURNET AVE | ||||||||
| Address2: | STE. 404 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003575728 | ||||||||
| FaxNumber: | 9372912962 | ||||||||
| Practice Location | |||||||||
| Address1: | 3120 BURNET AVE | ||||||||
| Address2: | STE. 404 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132212595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5132212595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.