Provider Demographics
NPI:1558336180
Name:GOLDBERG, WILLIAM EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-731-4400
Mailing Address - Fax:617-731-5500
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE 2W
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-731-4400
Practice Address - Fax:617-731-5500
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1201298Medicaid
MAJ13301Medicare ID - Type Unspecified
MA1201298Medicaid