Provider Demographics
NPI:1952396186
Name:GOLDBERG, MARC ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ANDREW
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-584-4433
Mailing Address - Fax:918-584-4479
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5639
Practice Address - Country:US
Practice Address - Phone:918-584-4433
Practice Address - Fax:918-584-4479
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2019-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK20009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100198360AMedicaid