Provider Demographics
NPI:1154317121
Name:GOLDBERGER, RICHARD IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:IAN
Last Name:GOLDBERGER
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 1:5106 N ARMENIA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1433
Mailing Address - Country:US
Mailing Address - Phone:813-875-0074
Mailing Address - Fax:813-878-0186
Practice Address - Street 1:5106 N ARMENIA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1433
Practice Address - Country:US
Practice Address - Phone:813-875-0074
Practice Address - Fax:813-878-0186
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34601207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0624143OtherAETNA
FL04029OtherBCBS
FL04029OtherBCBS
FLD50904Medicare UPIN