Provider Demographics
NPI:1790723666
Name:GOLDBERG, HELEN LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:LAURA
Last Name:GOLDBERG
Suffix:
Gender:F
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:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-399-2895
Mailing Address - Fax:970-874-6017
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-7878
Practice Address - Fax:360-414-7876
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9059207RH0003X
CODR0032488207RH0003X
WAMD61103919207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2332650OtherTAX ID
CO01324888Medicaid
TX042693402Medicaid
TX328346YPYROtherMEDICARE PTAN
TX042693402Medicaid