Provider Demographics
NPI:1649370966
Name:DAVID GOLDBERG MD
Entity type:Organization
Organization Name:DAVID GOLDBERG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-879-7710
Mailing Address - Street 1:68 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6671
Mailing Address - Country:US
Mailing Address - Phone:508-879-7710
Mailing Address - Fax:508-879-2154
Practice Address - Street 1:68 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6671
Practice Address - Country:US
Practice Address - Phone:508-879-7710
Practice Address - Fax:508-879-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA555571207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3067351Medicaid
MA3067351Medicaid
MAJ09666Medicare ID - Type Unspecified