Provider Demographics
NPI:1629028238
Name:GOLDBERG, ERIC J (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
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 1:2876 GUARDIAN LANE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7327
Mailing Address - Country:US
Mailing Address - Phone:757-463-5240
Mailing Address - Fax:757-463-6572
Practice Address - Street 1:3235 ACADEMY AVE
Practice Address - Street 2:STE 305
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3200
Practice Address - Country:US
Practice Address - Phone:757-686-9300
Practice Address - Fax:757-686-1514
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA283422OtherMPIPA OPTIMA CHOICE
NC063EGOtherBLUE CROSS BLUE SHIELD
VA7114486Medicaid
VA0500484OtherUNITED HEALTHCARE
VA31253OtherSENTARA
NC89063EGMedicaid
VA283422OtherALLIANCE MAMSI
VA317408OtherANTHEM
NC063EGOtherBLUE CROSS BLUE SHIELD