Provider Demographics
NPI:1184626111
Name:GOLDFARB, I. WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:I. WILLIAM
Middle Name:
Last Name:GOLDFARB
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 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-0282
Mailing Address - Fax:412-578-0259
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 338
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-0282
Practice Address - Fax:412-578-0259
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035411L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000469OtherGATEWAY HEALTH PLAN
PA2071881OtherAETNA USHC
PA0009139840001Medicaid
PA1299487OtherCIGNA
PA149119OtherHIGHMARK
PA149119OtherHIGHMARK
PA1000469OtherGATEWAY HEALTH PLAN