Provider Demographics
NPI:1861519910
Name:DON L. GOLDENBERG MD PC
Entity type:Organization
Organization Name:DON L. GOLDENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-243-5440
Mailing Address - Street 1:PO BOX 848740
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8740
Mailing Address - Country:US
Mailing Address - Phone:617-243-5440
Mailing Address - Fax:617-243-6453
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-243-5440
Practice Address - Fax:617-243-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA034653OtherTUFTS HEALTH PLAN
MA25022OtherHARVARD PILGRIM HEALTH
MA9757562Medicaid
MAM14823OtherBCBS
MA25022OtherHARVARD PILGRIM HEALTH
MAD82794Medicare UPIN