Glenn David Goldman, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

0420009351 Issued in VT

Practice address

354 Mountain View Dr Ste 300
Colchester, VT 05446-5988

Phone

(802) 864-0192

Fax

(802) 860-4919

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

No

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

• Green Mountain Dermatology PLLC

  • Dermatology Physician
  • Colchester, VT
  • NPI 1093577827
  Medicare reassignment Care Compare group NPD Dermatology, VT
• Four Seasons Dermatology LLC

  • Dermatology Physician
  • Colchester, VT
  • NPI 1790737393
  Medicare reassignment NPD Dermatology, VT
• University of Vermont Medical Center Inc

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment NPD VT
• Fletcher Allen Health Care Inc

  • Radiation Oncology Physician
  • Burlington, VT
  • NPI 1619266624
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of Vermont Medical Center Inc

  • General Acute Care Hospital
  • Burlington, VT
  • NPI 1568419976
  Care Compare affiliation Hospital

Specialty

Dermatology

Education

JS Weill Medical College, Cornell University, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Green Mountain Dermatology PLLC 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003

Procedures performed for Medicare patients

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ggoldman10412@direct.uvmhealth.org
• Direct secure messaging: ggoldman@fourseasonsderm.emadirect.md

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 5, 2024.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1992717458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 CHAMBERLIN LN",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054954406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 MOUNTAIN VIEW DR STE 300",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465988",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Colchester Ave",
            "address_2": "WP - 5",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "VT",
            "postal_code": "054011473",
            "country_code": "US",
            "telephone_number": "802-847-4570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "GLENN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-03-05",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "VT",
            "license": "0420009351",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VT",
            "license": "0420009351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN1395",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01669910",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Gibilisco, DMD
• Anne-Marie Gleeson, NP
• GM Operations LLC
• Jaime Goddette, PT
• Golden Colchester PLLC
• Amanda Goldstein, DPT
• Kathryn Gonzalez, MD
• Anita Louise Goodrich, MD
• Lisa Bartlett Goodwin, P.T.
• Amela Graco, LCMHC

• All providers in Colchester, VT
• MOHS-Micrographic Surgery Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.