Provider Demographics
NPI:1407947138
Name:GOLDBACH, PETER D (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:GOLDBACH
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 1:31 GREENSBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1126
Mailing Address - Country:US
Mailing Address - Phone:617-246-4936
Mailing Address - Fax:617-246-4630
Practice Address - Street 1:401 PARK DR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3325
Practice Address - Country:US
Practice Address - Phone:617-246-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49508207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease