Provider Demographics
NPI:1639122492
Name:GOLDBERG, TODD H (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:H
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3788
Mailing Address - Country:US
Mailing Address - Phone:215-481-2000
Mailing Address - Fax:
Practice Address - Street 1:1235 OLD YORK RD STE 214
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3841
Practice Address - Country:US
Practice Address - Phone:215-481-4811
Practice Address - Fax:215-576-1787
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22946207R00000X
PAMD034148E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA577633OtherMEDICARE
WV3810010622Medicaid
PA001051523Medicaid
PA001051523Medicaid