Provider Demographics
NPI:1396745808
Name:GOLDBERG, LISA A (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2586
Mailing Address - Country:US
Mailing Address - Phone:412-421-1324
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2790 MOSSIDE BLVD STE 720
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2757
Practice Address - Country:US
Practice Address - Phone:412-372-2770
Practice Address - Fax:412-372-4656
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025821E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C29266Medicare UPIN
081640E59Medicare ID - Type Unspecified