Provider Demographics
NPI:1790773174
Name:GOREN, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:GOREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1132 HAINESPORT MOUNT LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9501
Mailing Address - Country:US
Mailing Address - Phone:856-778-7301
Mailing Address - Fax:856-552-0777
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-668-3505
Practice Address - Fax:610-668-3509
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021884E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790773174OtherNPI
PA051224Medicare PIN
1790773174OtherNPI