Provider Demographics
NPI:1457331191
Name:GOLDBERG, KAREN Y (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:Y
Last Name:GOLDBERG
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 1:1110 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1858
Mailing Address - Country:US
Mailing Address - Phone:203-421-3600
Mailing Address - Fax:203-421-3627
Practice Address - Street 1:1110 DURHAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1858
Practice Address - Country:US
Practice Address - Phone:203-421-3600
Practice Address - Fax:203-421-3627
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0377502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine