Provider Demographics
NPI:1306820113
Name:GOLDBERGER, NEAL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:MICHAEL
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 1:701 EAST ROOSEVELT BLVD
Mailing Address - Street 2:BUILDING 600
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5170
Mailing Address - Country:US
Mailing Address - Phone:704-289-4595
Mailing Address - Fax:704-296-9707
Practice Address - Street 1:701 E ROOSEVELT BLVD
Practice Address - Street 2:STE 200-A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-289-4595
Practice Address - Fax:704-296-9707
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100039208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128HEMedicaid
SCN00039Medicaid
NC2283050AMedicare ID - Type Unspecified
SCE392514632Medicare ID - Type Unspecified
SCN00039Medicaid