Healthcare Provider Details

I. General information

NPI: 1982830782
Provider Name (Legal Business Name): GREGG HARRISON GOLDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

IV. Provider business mailing address

117 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

V. Phone/Fax

Practice location:
  • Phone: 919-334-3900
  • Fax:
Mailing address:
  • Phone: 919-334-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberTRN
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2013-01634
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: