Provider Demographics
NPI:1265401343
Name:GOLDBERG, AMIT (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KENTUCKY AVE.
Mailing Address - Street 2:CANCER CENTER STE. 201
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3813
Mailing Address - Country:US
Mailing Address - Phone:270-554-0011
Mailing Address - Fax:855-782-1232
Practice Address - Street 1:2501 KENTUCKY AVE.
Practice Address - Street 2:CANCER CENTER STE. 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3813
Practice Address - Country:US
Practice Address - Phone:270-554-0011
Practice Address - Fax:855-782-1232
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46146207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638815Medicaid
NY02638815Medicaid
NY2Z4161Medicare ID - Type Unspecified