Provider Demographics
NPI:1245297175
Name:GOLDBERGER, ANDREW ROBERT (CRNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:GOLDBERGER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1612 PARK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5627
Mailing Address - Country:US
Mailing Address - Phone:410-747-5830
Mailing Address - Fax:410-747-5831
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:SUITE 128
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4447
Practice Address - Country:US
Practice Address - Phone:410-590-4141
Practice Address - Fax:410-590-4159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR126347363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health