Provider Demographics
NPI:1104822857
Name:GOLDBERG, FREDRIC HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:HOWARD
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-949-5317
Practice Address - Street 1:380 OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8304
Practice Address - Country:US
Practice Address - Phone:215-949-5311
Practice Address - Fax:215-949-5317
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-042377-L207L00000X
PAMD042377L208VP0000X
NJ25MA08301300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015119460010Medicaid
PA30070981OtherKEYSTONE MERCY
PA616889OtherAETNA HMO
PA1511946Medicaid
PA698885OtherHIGHMARK BLUE SHIELD
PA0534094000OtherKEYSTONE IBC
PAP00760072OtherRAILROAD MEDICARE
PA23062MD042377LOtherHEALTH PARTNERS
F07431Medicare UPIN
PA0015119460010Medicaid
PA23062MD042377LOtherHEALTH PARTNERS