Healthcare Provider Details

I. General information

NPI: 1326033242
Provider Name (Legal Business Name): MERYL G GOLDHABER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD
WARWICK RI
02886-4394
US

IV. Provider business mailing address

227 CENTERVILLE RD
WARWICK RI
02886-4394
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-3332
  • Fax: 401-739-0196
Mailing address:
  • Phone: 401-732-3332
  • Fax: 401-739-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD10336
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number10336
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10336
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: