Provider Demographics
NPI:1821261298
Name:ENDOSCOPY CENTER OF NORTH BALTLIMORE
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF NORTH BALTLIMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-4415
Mailing Address - Street 1:1220C E JOPPA RD
Mailing Address - Street 2:SUITE A508
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5814
Mailing Address - Country:US
Mailing Address - Phone:410-296-4415
Mailing Address - Fax:410-296-4417
Practice Address - Street 1:1220C E JOPPA RD
Practice Address - Street 2:SUITE A508
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5814
Practice Address - Country:US
Practice Address - Phone:410-296-4415
Practice Address - Fax:410-296-4417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDOSCOPY CENTER OF NORTH BALTIMORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1385261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMG001Medicare PIN