Provider Demographics
NPI:1871526723
Name:GOLDSMITH, MARK STEVEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:GOLDSMITH
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG448902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G4489020Medicare PIN
CA00G4489015Medicare PIN
CA00G4489016Medicare PIN
CA300097024Medicare PIN
CA00G448903Medicare PIN
CA00G4489011Medicare PIN
CA00G4489019Medicare PIN
CA00G448902Medicare PIN
CA00G4489021Medicare PIN
CA00G448901Medicare PIN
CA00G4489014Medicare PIN
CA00G4489017Medicare PIN
CA00G448904Medicare PIN
CA300096980Medicare PIN
CAE28500Medicare UPIN
CA00G4489012Medicare PIN
CA00G448906Medicare PIN
CA00G448907Medicare PIN
CA00G448909Medicare PIN
CA00G4489010Medicare PIN
CA00G4489018Medicare PIN
CA00G4489022Medicare PIN
CA00G448905Medicare PIN
CA00G448908Medicare PIN