Provider Demographics
NPI:1912968264
Name:GOLDBERG, STEVEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 SPRING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-6805
Mailing Address - Country:US
Mailing Address - Phone:717-540-5221
Mailing Address - Fax:
Practice Address - Street 1:25 N 32ND ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2918
Practice Address - Country:US
Practice Address - Phone:717-730-9782
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002946L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical