MEDICARE: STEPHEN J GOLDBERG MD

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	207RG0100X	Gastroenterology Physician	35-0322-15	OH

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	:	1760488993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J GOLDBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 8686
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-0686
Country	:	US
Telephone Number	:	513-686-5444
Fax Number	:	513-686-5443

Provider Business Practice Location Address
First Line	:	4777 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2725
Country	:	US
Telephone Number	:	513-686-5444
Fax Number	:	513-686-5443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	04/03/2012

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