Provider Demographics
NPI:1497779334
Name:GOLDBERG, HAROLD R (MD, FACC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:R
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0331
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:450
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-838-4978
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025218207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016690Medicaid
ID003152700Medicaid
WA060023161OtherRRB
WA060023161OtherRRB
WA1016690Medicaid
WAG000357307Medicare PIN