Provider Demographics
NPI:1801868864
Name:GOLDBERGER, STEPHEN H (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:GOLDBERGER
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:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901
Mailing Address - Country:US
Mailing Address - Phone:434-315-5551
Mailing Address - Fax:434-315-5524
Practice Address - Street 1:808 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-315-5551
Practice Address - Fax:434-315-5524
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057289207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010120519Medicaid
VA010120519Medicaid
A43998Medicare UPIN