Provider Demographics
NPI:1841409042
Name:GOLDBERG, STEPHANIE R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-9734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:SURGERY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-827-1207
Practice Address - Fax:804-827-0701
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247884208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery