Healthcare Provider Details

I. General information

NPI: 1366418733
Provider Name (Legal Business Name): MICHAEL H. GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD SUITE 300
SPRINGFIELD VA
22152-1800
US

IV. Provider business mailing address

8134 OLD KEENE MILL RD SUITE 300
SPRINGFIELD VA
22152-1800
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6111
  • Fax: 703-451-6247
Mailing address:
  • Phone: 703-451-6111
  • Fax: 703-451-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101030490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: