Provider Demographics
NPI:1982643144
Name:GOLDBERGER, SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:GOLDBERGER
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 1:223 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2013
Mailing Address - Country:US
Mailing Address - Phone:310-880-0017
Mailing Address - Fax:
Practice Address - Street 1:223 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2013
Practice Address - Country:US
Practice Address - Phone:310-880-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62027174400000X
MA266664207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G620270Medicaid
CAE91899Medicare UPIN
CAG62027Medicare ID - Type UnspecifiedLICENSE