Provider Demographics
NPI:1104836345
Name:GOLDBERG, AARON D (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:D
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 1:2835 SMITH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:140-358-4243
Mailing Address - Fax:410-358-1016
Practice Address - Street 1:2835 SMITH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:140-358-4243
Practice Address - Fax:410-358-1016
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG33974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110020756OtherMEDICARE RAILROAD
MD208771500Medicaid
MD208771500Medicaid