Provider Demographics
NPI:1134182181
Name:STEPHEN H GOLDBERGER, MD
Entity type:Organization
Organization Name:STEPHEN H GOLDBERGER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-315-5551
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0920
Mailing Address - Country:US
Mailing Address - Phone:434-315-5551
Mailing Address - Fax:
Practice Address - Street 1:830 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1112
Practice Address - Country:US
Practice Address - Phone:434-315-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010120519Medicare ID - Type UnspecifiedINDIVIDUAL MCD #
VA190001207Medicare ID - Type UnspecifiedINDIVIDUAL MCR #