Provider Demographics
NPI:1417971649
Name:GOLDBERG, RONALD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
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 1:5400 SUTLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4721
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:912-355-9807
Practice Address - Street 1:225 CANDLER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-355-0596
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020433207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000177526BMedicaid
GA000177526FMedicaid
GA000177526HMedicaid
SC314988Medicaid
GA020433OtherMEDICAL LICENSE
D39969Medicare UPIN
GA000177526HMedicaid
SC314988Medicaid
GA900000821Medicare PIN