Provider Demographics
NPI:1710968102
Name:GOLDBERG, STEPHEN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRUCE
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2 RESERVOIR CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6393
Mailing Address - Country:US
Mailing Address - Phone:410-653-2647
Mailing Address - Fax:410-653-7778
Practice Address - Street 1:2 RESERVOIR CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6393
Practice Address - Country:US
Practice Address - Phone:410-653-2647
Practice Address - Fax:410-653-7778
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO00689852084P0800X
MT1323652084P0800X, 2084F0202X
ND206382084P0800X
MDD470012084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry