Provider Demographics
NPI:1346286564
Name:GOLDBERG, MARTIN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:RICHARD
Last Name:GOLDBERG
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 1:1201 ALHAMBRA BLVD
Mailing Address - Street 2:410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5243
Mailing Address - Country:US
Mailing Address - Phone:916-457-4263
Mailing Address - Fax:916-731-7809
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:#410
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-457-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46741Medicare UPIN
CA1346286564Medicare NSC