Healthcare Provider Details

I. General information

NPI: 1548246440
Provider Name (Legal Business Name): THOMAS ALAN GOLDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 MICA DR
CARSON CITY NV
89705-7269
US

IV. Provider business mailing address

2161 MONTEREY DR
SOUTH LAKE TAHOE CA
96150-6729
US

V. Phone/Fax

Practice location:
  • Phone: 775-267-6700
  • Fax: 775-267-6609
Mailing address:
  • Phone: 530-318-9903
  • Fax: 530-541-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5775
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5775
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: