Active NPI
Marcus Jacob Goldman, M.D.
- Psychiatry Physician
- Sudbury, MA
National Provider Identifier
1023022639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 59122
- Practice address
- 138 Peakham Rd
Sudbury, MA 01776-2916 - Phone
- (978) 808-7533
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | 59122 | MA | |
| Psychiatry Physician | 2084P0800X | 59122 | MA | Primary |
| Addiction Psychiatry Physician | 2084P0802X | 59122 | MA | |
| Geriatric Psychiatry Physician | 2084P0805X | 59122 | MA |
Addresses
Primary practice location
138 Peakham Rd
Sudbury, MA 01776-2916
Mailing address
138 Peakham Rd
Sudbury, MA 01776-2916
Phone (978) 808-7533
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3094511 | Medicaid | MA | |
| J12267 | Other | MA | BLUE SHIELD |
| 765922 | Other | MA | TUFTS |
| 26793 | Other | MA | HEALTHNET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59122 | MA | MD | Addiction Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1023022639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 PEAKHAM RD",
"city": "SUDBURY",
"state": "MA",
"postal_code": "017762916",
"telephone_number": "978-808-7533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 PEAKHAM RD",
"city": "SUDBURY",
"state": "MA",
"postal_code": "017762916",
"telephone_number": "978-808-7533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDMAN",
"first_name": "MARCUS",
"middle_name": "JACOB",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "MA",
"license": "59122",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "59122",
"primary": true
},
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "MA",
"license": "59122",
"primary": false
},
{
"code": "2084P0805X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Geriatric Psychiatry",
"state": "MA",
"license": "59122",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3094511",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "J12267",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "765922",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "26793",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sudbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.