Provider Demographics
NPI:1205862372
Name:GOLDBERG, CRAIG E (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
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 2388
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05303-2388
Mailing Address - Country:US
Mailing Address - Phone:802-254-4545
Mailing Address - Fax:802-254-0079
Practice Address - Street 1:1027 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-4545
Practice Address - Fax:802-254-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0320000406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04YP03636VT01OtherANTHEM BLUE CROSS BLUE SH
10819350OtherBLUE CROSS BLUE SHIELD
08P023OtherMOHAWK VALLEY PLAN
080055781OtherUNITED HEALTHCARE RAILROA
10819350OtherBLUE CROSS BLUE SHIELD
F68044Medicare UPIN