Provider Demographics
NPI:1558449587
Name:GOLDBERG, CATHRYN A (MD)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:F
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:DEPARTMENT 4387
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4387
Mailing Address - Country:US
Mailing Address - Phone:630-355-0450
Mailing Address - Fax:630-527-3911
Practice Address - Street 1:801 S WASHINGTON STREET
Practice Address - Street 2:EDWARD HOSPITAL
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60566-7060
Practice Address - Country:US
Practice Address - Phone:630-355-0450
Practice Address - Fax:630-527-3911
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360946803Medicaid
ILL93703Medicare ID - Type Unspecified
G70734Medicare UPIN