Provider Demographics
NPI:1518070952
Name:GOLDBERG, ALBERT CHESTER (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:CHESTER
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 LAS GALLINAS AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-479-7244
Mailing Address - Fax:415-479-8162
Practice Address - Street 1:750 LAS GALLINAS AVE
Practice Address - Street 2:STE 210
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-479-7244
Practice Address - Fax:415-479-8162
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG9946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000AG99460Medicaid
CA000AG99460Medicaid