Provider Demographics
NPI:1033167648
Name:GOLDBERGER, STEPHEN GILBERT
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GILBERT
Last Name:GOLDBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 109TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1814
Mailing Address - Country:US
Mailing Address - Phone:239-513-7930
Mailing Address - Fax:239-513-1915
Practice Address - Street 1:878 109TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1814
Practice Address - Country:US
Practice Address - Phone:239-513-7930
Practice Address - Fax:239-513-1915
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016646207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD115640300Medicaid
MD115640300Medicaid
MD016952M12Medicare PIN