Provider Demographics
NPI:1366598013
Name:GOLDING, NICOLE B (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:GOLDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-913-5470
Mailing Address - Fax:505-913-6489
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-913-5470
Practice Address - Fax:505-913-6489
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430700208100000X
NMMD2011-0221208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00166968OtherRAILROAD MEDICARE
KS200265340AMedicaid
KS104211OtherBLUE CROSS BLUE SHIELD
KS200335260AMedicaid
KS200335260AMedicaid
KS111063Medicare ID - Type UnspecifiedGROUP ID
KS200265340AMedicaid