1023031176 NPI number — DR. NELSON H. GOLDBERG M.D.

Table of content: ELIZABETH KELLY RN (NPI 1346138369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023031176 NPI number — DR. NELSON H. GOLDBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERG
Provider First Name:
NELSON
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023031176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-6897
Provider Business Mailing Address Fax Number:
410-328-2109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21264-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6897
Provider Business Practice Location Address Fax Number:
410-328-2109
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  D15694 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32137002 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 80019 . This is a "GEISINGER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003263 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 305241900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: F821 . This is a "CAREFIRST REGIONAL GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 213357 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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