Provider Demographics
NPI:1861554735
Name:GOLDBERG, ROSS TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:TERRY
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:#110
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4743
Mailing Address - Country:US
Mailing Address - Phone:310-394-2761
Mailing Address - Fax:310-394-2766
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:#110
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4743
Practice Address - Country:US
Practice Address - Phone:310-394-2761
Practice Address - Fax:310-394-2766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-11-12
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Provider Licenses
StateLicense IDTaxonomies
CAG344772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45943Medicare UPIN