Provider Demographics
NPI:1538133244
Name:GOLDBERG, MARTIN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOSEPH
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 1:301 RIVERVIEW AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9365
Mailing Address - Fax:757-962-7217
Practice Address - Street 1:301 RIVERVIEW AVE STE 700
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9365
Practice Address - Fax:757-962-7217
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA027792OtherANTHEM BC/BS
NC05699OtherBC/BS NC
VA249504OtherMAMSI
VA15961OtherOPTIMA
VA250373OtherANTHEM BC/BS
NC7905699Medicaid
VA006033717Medicaid
VA006074855Medicaid
VA15792OtherSENTARA OHP/SHP
VA263654OtherUHC/MAMSI/MDIPA
VA006074855Medicaid
VA006033717Medicaid
VA110006057Medicare PIN
VA250373OtherANTHEM BC/BS
VA060039268Medicare PIN