Provider Demographics
NPI:1962481028
Name:GOLDBERG, TODD MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 361
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-432-7900
Mailing Address - Fax:954-433-4903
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:#361
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-432-7900
Practice Address - Fax:954-433-4903
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375827300Medicaid
FL80888OtherBCBS
FL80888NMedicare PIN
FL80888VMedicare PIN
FL80888WMedicare PIN
FL80888XMedicare PIN
FL80888QMedicare PIN
FL375827300Medicaid
FL80888SMedicare PIN
FL80888OtherBCBS
FL80888UMedicare PIN
FL80888TMedicare PIN
FL80888RMedicare PIN
FL80888PMedicare PIN