Provider Demographics
NPI:1164660080
Name:AARON D. GOLDBERG MD, CHTD.
Entity Type:Organization
Organization Name:AARON D. GOLDBERG MD, CHTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-358-4243
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:21209-1453
Mailing Address - Country:US
Mailing Address - Phone:410-358-4243
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:21209-1453
Practice Address - Country:US
Practice Address - Phone:410-358-4243
Practice Address - Fax:410-358-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care