Provider Demographics
NPI:1629168331
Name:GOLDBACH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GOLDBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:100 S 10TH ST
Practice Address - Street 2:STE B
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6690
Practice Address - Country:US
Practice Address - Phone:910-984-8229
Practice Address - Fax:910-514-9717
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36109OtherBCBS OF NC
NC4632613OtherCOVENTRY NATIONAL - COVENTRY PPO
NC1629168331OtherHUMANA
NC1579842OtherCOVENTRY OF THE CAROLINAS
NC1629168331OtherHEALTHSMART
NC1629168331Medicaid
NC300048OtherMEDCOST
NCFH1101930OtherFIRST CAROLINA CARE
NC1218394OtherUNITED HEALTHCARE
NC12347387OtherPHCS-MULTIPLAN
NC1281259OtherCIGNA
NC1629168331OtherHEALTHNET FEDERAL SERVICES
NC8936109Medicaid
NC1579842OtherWELLPATH
NC1629168331OtherDOCTORS DIRECT
NC4544829OtherAETNA
NC1629168331Medicaid