Provider Demographics
NPI:1871581827
Name:GOLDMAN, BRUCE I (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:I
Last Name:GOLDMAN
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 626 URMC
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3401
Mailing Address - Fax:585-273-3637
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 626 URMC
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3401
Practice Address - Fax:585-273-3637
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 038843E207ZP0105X
NY149875207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010930960001Medicaid
NYRB2486Medicare PIN
168184D6LMedicare ID - Type Unspecified
C32646Medicare UPIN