Phyllis H Goltra, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS 006504-L Issued in PA

Practice address

1616 Walnut St
Suite 1616
Philadelphia, PA 19103-5313

Phone

(215) 545-8441

Fax

(215) 985-1129

NPI assigned

Sep 2, 2005

Last updated

Mar 24, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Phyllis H Goltra Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Phyllis H. Goltra, P.C.

  • Psychologist
  • Philadelphia, PA
  • NPI 1164487500
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237852800000",
    "number": "1467446625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 WALNUT ST",
            "address_2": "SUITE 1616",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191035313",
            "telephone_number": "215-545-8441",
            "fax_number": "215-985-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 WALNUT ST",
            "address_2": "SUITE 1616",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191035313",
            "telephone_number": "215-545-8441",
            "fax_number": "215-985-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLTRA",
        "first_name": "PHYLLIS",
        "middle_name": "H",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2009-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS 006504-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "GOLTRA",
            "middle_name": "H",
            "credential": "PC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Yuliya Golkov
• Satya P Gollamudi, M.D.
• Kandace Gollomp, MD
• Klevi Golloshi
• Victoria Nicole Golson, CRNP-PC
• Alexa Golub, DO
• Robert M Golub, M.D.
• Joshua Louis Golubovsky
• Sohil Golwala, MD
• Goma Home & Companion Care LLC

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.