Healthcare Provider Details

I. General information

NPI: 1265540033
Provider Name (Legal Business Name): LAURA D GOLDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA D DUNN

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax: 440-449-1555
Mailing address:
  • Phone: 440-684-5829
  • Fax: 440-449-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-086277
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: