Healthcare Provider Details

I. General information

NPI: 1013137751
Provider Name (Legal Business Name): KAREN A GOLDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 COOK ST
BRANDON FL
33511-5216
US

IV. Provider business mailing address

PO BOX 4111
BRANDON FL
33509-4111
US

V. Phone/Fax

Practice location:
  • Phone: 813-502-5272
  • Fax: 813-502-6741
Mailing address:
  • Phone: 813-716-8547
  • Fax: 813-502-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 90453
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 90453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: