Provider Demographics
NPI:1841378841
Name:GOLDBERG, MARSHALL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:G
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 1:5353 BALBOA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2804
Mailing Address - Country:US
Mailing Address - Phone:818-789-7181
Mailing Address - Fax:818-986-8322
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-789-7181
Practice Address - Fax:818-986-8322
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC255992080A0000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Not Answered2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87027Medicare UPIN