Provider Demographics
NPI:1497256317
Name:GOLDBERG DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:GOLDBERG DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-595-0151
Mailing Address - Street 1:990 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1395
Mailing Address - Country:US
Mailing Address - Phone:781-595-0151
Mailing Address - Fax:781-592-6780
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:781-595-0151
Practice Address - Fax:781-592-6780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD S GOLDBERG MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-26
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty