MEDICARE: NEIL A 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	208000000X	Pediatrics Physician	40222	CO

General Provider Information

NPI Number	:	1821083742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL A GOLDBERG MD

Provider Business Mailing Address
First Line	:	7373 W JEFFERSON AVE
Second Line	:	SUITE 102
City	:	LAKEWOOD
State	:	CO
Zip	:	80235-2038
Country	:	US
Telephone Number	:	303-988-5252
Fax Number	:	303-988-5632

Provider Business Practice Location Address
First Line	:	7373 W JEFFERSON AVE
Second Line	:	SUITE 102
City	:	LAKEWOOD
State	:	CO
Zip	:	80235-2038
Country	:	US
Telephone Number	:	303-988-5252
Fax Number	:	303-988-5632

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/08/2007

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