Provider Demographics
NPI:1700877834
Name:GOLDBERG, MARCIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRJ 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3812
Practice Address - Fax:617-726-7416
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2019-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA56677207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3199754Medicaid
MAJ21620OtherBCBS MA
MA056677OtherTUFTS HEALTH PLAN
MA056677OtherTUFTS HEALTH PLAN
MA3199754Medicaid