Provider Demographics
NPI:1033209176
Name:GOLDBERG, SCOT E (DO)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:E
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-993-2330
Mailing Address - Fax:302-993-2344
Practice Address - Street 1:J24 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2060
Practice Address - Country:US
Practice Address - Phone:302-738-9100
Practice Address - Fax:302-738-9748
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20059632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003464B93Medicare PIN
DE003460G66Medicare PIN
DEC30397Medicare UPIN
003461M26Medicare PIN
DE003462P97Medicare PIN
DEG02414D02Medicare PIN
DE003463O73Medicare PIN