Healthcare Provider Details

I. General information

NPI: 1629168331
Provider Name (Legal Business Name): ROBERT GOLDBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 10TH ST STE B
LILLINGTON NC
27546-6690
US

IV. Provider business mailing address

PO BOX 647
HOPE MILLS NC
28348-0647
US

V. Phone/Fax

Practice location:
  • Phone: 910-984-8229
  • Fax: 910-514-9717
Mailing address:
  • Phone: 910-483-7337
  • Fax: 910-483-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9400254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: