Provider Demographics
NPI:1558308437
Name:GOOSENBERG, ERIC B (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:GOOSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1095 RYDAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1711
Mailing Address - Country:US
Mailing Address - Phone:267-620-1100
Mailing Address - Fax:215-572-1279
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:215-572-1279
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033890E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1157791OtherKEYSTONE MERCY
PA231937219OtherMULTIPLAN
PA000192796Medicaid
PA1158808003OtherCIGNA
PA231937219OtherFIRST HEALTH
PA000192796OtherPERSONAL CHOICE
PA000192796OtherHIGHMARK BLUE SHIELD
PA14617OtherHEALTH PARTNERS
PA231937219OtherDEVON
PA231937219OtherTRICARE
PA0054626000OtherKEYSTONE EAST
PA4201468OtherAETNA
PA000192796OtherAMERIHEALTH
PA100015956OtherPALMETTO GBA
PA231937219OtherFIRST HEALTH