Provider Demographics
NPI:1326033242
Name:GOLDHABER, MERYL G (MD)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:G
Last Name:GOLDHABER
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 1:227 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-732-3332
Mailing Address - Fax:401-739-0196
Practice Address - Street 1:227 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-3332
Practice Address - Fax:401-739-0196
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10336174400000X
RI103362084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5986974001OtherCIGNA
ID103360OtherTUFTS
RI1326033242OtherNPI
RI21342OtherBLUE CROSS BLUE SHIELD
RI2499541OtherAETNA
RIAA2917OtherPILGRIM
RI130026411OtherRAILROAD MEDICARE
RI407238OtherBLUE CHIP
RI050513332OtherUNITED HEALTH CARE
RI050513332OtherCHAMPUS
RI7008535Medicaid
RI1326033242OtherNPI
RI2499541OtherAETNA