Healthcare Provider Details

I. General information

NPI: 1235137258
Provider Name (Legal Business Name): GARY GOLDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 LOCUST ST SUITE 409
PITTSBURGH PA
15219-4738
US

IV. Provider business mailing address

1350 LOCUST ST SUITE 409
PITTSBURGH PA
15219-4738
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-7608
  • Fax:
Mailing address:
  • Phone: 412-232-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD022752E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: