Healthcare Provider Details

I. General information

NPI: 1235318460
Provider Name (Legal Business Name): CORINNE GOLDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 PARK RD
CHARLOTTE NC
28203-5926
US

IV. Provider business mailing address

2425 PARK RD
CHARLOTTE NC
28203-5926
US

V. Phone/Fax

Practice location:
  • Phone: 704-347-8346
  • Fax:
Mailing address:
  • Phone: 704-347-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number2009-01906
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: