Provider Demographics
NPI:1245299023
Name:GOLBERG, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GOLBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 847804
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7804
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-767-1604
Practice Address - Street 1:219 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4741
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-767-1604
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34323207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74083Medicare UPIN