Provider Demographics
NPI:1033172507
Name:GOLDBERG, HOWARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LANDINGS DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9408
Mailing Address - Country:US
Mailing Address - Phone:724-225-8995
Mailing Address - Fax:724-225-9874
Practice Address - Street 1:80 LANDINGS DR
Practice Address - Street 2:SUITE 207
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9408
Practice Address - Country:US
Practice Address - Phone:724-225-8995
Practice Address - Fax:724-225-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073616L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001899674Medicaid
PAH66377Medicare UPIN
PA059758Medicare ID - Type Unspecified