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

Last updated

Oct 22, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

Enrollment records 1

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 PLLCGroup PAC ID 4688011992, 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 enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Green Mountain Dermatology PLLC

  dba Four Seasons Dermatology

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

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

  dba Uvm Medical Center

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment NPD
• 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

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792627200000",
    "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": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VT",
            "license": "0420009351",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "VT",
            "license": "0420009351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• MOHS-Micrographic Surgery Physician in Colchester, VT
• Providers in Colchester, VT by specialty
• MOHS-Micrographic Surgery Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; 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.