Provider Demographics
NPI:1538621594
Name:GOIKHBERG, KASANIA (MD)
Entity type:Individual
Prefix:DR
First Name:KASANIA
Middle Name:
Last Name:GOIKHBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KASANIA
Other - Middle Name:
Other - Last Name:SHUISKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:PATRICK 434
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-842-2700
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:PATRICK 434
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-842-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program