Provider Demographics
NPI:1386662989
Name:GOLDENBERG, JILL D (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:GOLDENBERG
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 1:950 E HARVARD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7006
Mailing Address - Country:US
Mailing Address - Phone:303-649-3200
Mailing Address - Fax:303-765-3201
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7006
Practice Address - Country:US
Practice Address - Phone:303-649-3200
Practice Address - Fax:303-765-3201
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42941208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58955313Medicaid
COCOAAA1202Medicare PIN