Provider Demographics
NPI:1780625509
Name:GOLDBERG, NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:GOLDBERG
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 1:3535 RANDOLPH RD
Mailing Address - Street 2:STE 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1082
Mailing Address - Country:US
Mailing Address - Phone:704-442-9805
Mailing Address - Fax:704-405-0868
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:STE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1082
Practice Address - Country:US
Practice Address - Phone:704-442-9805
Practice Address - Fax:704-405-0868
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160284174400000X
NC2013-01786207RA0401X, 208100000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01362147Medicaid
NY37L141Medicare PIN
NY11442683OtherCAQH
NYP00449078OtherRAILROAD MEDICARE
NY880S91OtherEMPIRE BLUE SHIELD
NYF20398Medicare UPIN