Healthcare Provider Details

I. General information

NPI: 1447256714
Provider Name (Legal Business Name): MARC EVAN GOLDBERG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 OLANDWOOD CT SUITE 204
OLNEY MD
20832-1367
US

IV. Provider business mailing address

3408 OLANDWOOD CT SUITE 204
OLNEY MD
20832-1367
US

V. Phone/Fax

Practice location:
  • Phone: 301-924-5044
  • Fax: 301-924-5933
Mailing address:
  • Phone: 301-924-5044
  • Fax: 301-924-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: