Provider Demographics
NPI:1841282340
Name:GOLOMB, ROGER STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:STEVEN
Last Name:GOLOMB
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 1:1122 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4100
Mailing Address - Country:US
Mailing Address - Phone:727-461-2282
Mailing Address - Fax:
Practice Address - Street 1:1122 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4100
Practice Address - Country:US
Practice Address - Phone:727-461-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0021279207NS0135X
FLME0021279207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77445OtherMEDICARE GROUP PROV NUMBE
FL2127587OtherAETNA
FL0305012OtherUNITED HEALTH CARE
FL78014ZOtherBLUE CROSS BLUE SHIELD
FL2147510OtherPROVIDER NUMBER
FL2127587OtherAETNA
D58328Medicare UPIN