Provider Demographics
NPI:1780983148
Name:GOMBERG, MONICA (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GOMBERG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARRISON AVE #605
Mailing Address - Street 2:PMB 62564
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:888-404-4813
Mailing Address - Fax:888-675-4061
Practice Address - Street 1:68 HARRISON AVE #605
Practice Address - Street 2:PMB 62564
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:888-404-4813
Practice Address - Fax:888-675-4061
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48682207RE0101X
IAMD-53098207RE0101X
NH33788207RE0101X
MO2024036194207RE0101X
SC93532207RE0101X
VA0101284622207RE0101X
MS33367207RE0101X
OH35C.001525207RE0101X
VT042.0017817-COMP207RE0101X
MA1021599207RE0101X
DEC1-0026861207RE0101X
MEMD28272207RE0101X
PAMD457345207RE0101X
LA341306207RE0101X
FLTPME5431207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism