Provider Demographics
NPI:1710954490
Name:GOLDBERG, DORIE E (PA)
Entity Type:Individual
Prefix:MS
First Name:DORIE
Middle Name:E
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 S DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5412
Mailing Address - Country:US
Mailing Address - Phone:407-843-1620
Mailing Address - Fax:407-843-5243
Practice Address - Street 1:2863 S DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5412
Practice Address - Country:US
Practice Address - Phone:407-843-1620
Practice Address - Fax:407-843-5243
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30956Medicare UPIN