Provider Demographics
NPI:1154316693
Name:GOLDBERG, BEVERLY A (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 VARNUM AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2109
Mailing Address - Country:US
Mailing Address - Phone:978-934-9220
Mailing Address - Fax:978-453-7771
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2109
Practice Address - Country:US
Practice Address - Phone:978-934-9220
Practice Address - Fax:978-453-7771
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77723207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA41500OtherFALLON
MA077723OtherTUFTS
MAPI12041160OtherMULTIPLAN
NY02551031Medicaid
MA2803598OtherAETNA
MAJ14721OtherBCBS
MA23740OtherHARVARD PILGRIM
MA976462OtherNETWORK HEALTH
MA0024274OtherNEIGHBORHOOD HEALTH PLAN
MA3129764Medicaid
MAJ14721OtherBCBS
MAPI12041160OtherMULTIPLAN
290014027Medicare ID - Type UnspecifiedMR RAILROAD