Provider Demographics
NPI:1689759045
Name:GOLDBERG, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 GUILDHALL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1562
Mailing Address - Country:US
Mailing Address - Phone:317-876-1652
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:IU HOSPITAL - LILLY CLINIC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-277-3827
Practice Address - Fax:317-276-5495
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN01035439A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN84195Medicare UPIN