Provider Demographics
NPI:1548246440
Name:GOLDENBERG, THOMAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALAN
Last Name:GOLDENBERG
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 1:2161 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6729
Mailing Address - Country:US
Mailing Address - Phone:530-318-9903
Mailing Address - Fax:530-541-6269
Practice Address - Street 1:961 MICA DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7269
Practice Address - Country:US
Practice Address - Phone:775-267-6700
Practice Address - Fax:775-267-6609
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5775207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548246440Medicaid
CA00G421120Medicare PIN
NV32119Medicare PIN
E61286Medicare UPIN