Provider Demographics
NPI:1982608543
Name:GOLDBERG, LAWRENCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7417 WESBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-4035
Mailing Address - Country:US
Mailing Address - Phone:502-423-0218
Mailing Address - Fax:502-423-0330
Practice Address - Street 1:1800 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1130
Practice Address - Country:US
Practice Address - Phone:502-367-3321
Practice Address - Fax:502-367-3322
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13489208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64134893Medicaid
KY1080574OtherPASSPORT
KY000000043074OtherANTHEMBLUECROSSBLUESHIELD
KY1080574OtherPASSPORT
KY64134893Medicaid