Provider Demographics
NPI:1588653703
Name:GOLDBERG, MARC J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 39209
Mailing Address - Street 2:SUITE F
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:8399 W. OAKLAND PARK BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7311
Practice Address - Country:US
Practice Address - Phone:954-578-2066
Practice Address - Fax:954-578-2595
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0032083207W00000X
FLME32083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038430500Medicaid
FL93074OtherBCBS
FL2798387OtherAETNA
FL202140OtherAV MED
FL2798387OtherAETNA
FL202140OtherAV MED
FLE14550Medicare UPIN