Provider Demographics
NPI:1629078530
Name:DAVID N. GOLDBERG, DO FACOOG PC
Entity Type:Organization
Organization Name:DAVID N. GOLDBERG, DO FACOOG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-664-6550
Mailing Address - Street 1:1 BALA AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3212
Mailing Address - Country:US
Mailing Address - Phone:610-664-6550
Mailing Address - Fax:610-660-0199
Practice Address - Street 1:1 BALA AVE
Practice Address - Street 2:STE 120
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3212
Practice Address - Country:US
Practice Address - Phone:610-664-6550
Practice Address - Fax:610-660-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty