Provider Demographics
NPI:1730265133
Name:GOLDBERG, CAROL A (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:730 W. HAMPDEN AVE.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110
Mailing Address - Country:US
Mailing Address - Phone:303-788-4660
Mailing Address - Fax:303-788-4878
Practice Address - Street 1:730 W. HAMPDEN AVE.
Practice Address - Street 2:SUITE 110
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110
Practice Address - Country:US
Practice Address - Phone:303-788-4660
Practice Address - Fax:303-788-4878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29930207RN0300X, 163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01299304Medicaid
CO01299304Medicaid
CO35081Medicare ID - Type Unspecified