Provider Demographics
NPI:1407895998
Name:GOLDBERG, MATTHEW J (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
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 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-868-3300
Mailing Address - Fax:603-868-3303
Practice Address - Street 1:65 CALEF HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03861-6703
Practice Address - Country:US
Practice Address - Phone:603-868-3300
Practice Address - Fax:603-868-3303
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11272207Q00000X
MEDO2216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075633Medicaid
ME1407895998Medicaid
ME1407895998Medicaid
NH3075633Medicaid