Provider Demographics
NPI:1740262641
Name:GOLDBERG, PINKUS (MD)
Entity type:Individual
Prefix:DR
First Name:PINKUS
Middle Name:
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:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-350-2163
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:9002 N MERIDIAN ST STE 107
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5349
Practice Address - Country:US
Practice Address - Phone:317-848-9441
Practice Address - Fax:317-924-8239
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033874A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100145290Medicaid
ININ1127026OtherMEDICARE PTAN
ININ1125027OtherMEDICARE PTAN
IN01033874AMedicaid
ININ1125004OtherMEDICARE PTAN
ININ1126004OtherMEDICARE PTAN
IN200809930Medicaid
IN000000475815OtherAACI BC/BS PIN NUMBER
ININ1127004OtherMEDICARE PTAN
IN234200HMedicare Oscar/Certification