Provider Demographics
NPI:1659417889
Name:GOLDBERG, PHILIP ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 BUSINESS PARK DRIVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-488-5885
Mailing Address - Fax:203-488-5899
Practice Address - Street 1:200 ORCHARD ST
Practice Address - Street 2:STE 207
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5363
Practice Address - Country:US
Practice Address - Phone:203-776-6644
Practice Address - Fax:203-776-4441
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037748207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
460000087Medicare ID - Type Unspecified
H04877Medicare UPIN