MEDICARE: LAWRENCE R. GOLDBERG M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0035408	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144530379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE R. GOLDBERG M.D. P.A.

Provider Business Mailing Address
First Line	:	4957 38TH AVE N
Second Line	:	SUITE D
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2174
Country	:	US
Telephone Number	:	727-521-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4957 38TH AVE N
Second Line	:	SUITE D
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2174
Country	:	US
Telephone Number	:	727-521-4669
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE GOLDBERG
Credential	:	M.D.
Telephone Number	:	727-521-4669

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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