Provider Demographics
NPI:1952797425
Name:GOLDBERG, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:GOLDBERG
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 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-975-1834
Practice Address - Street 1:29 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9602
Practice Address - Country:US
Practice Address - Phone:434-654-8900
Practice Address - Fax:844-527-9358
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264518207Q00000X
VA0101272335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine