Healthcare Provider Details

I. General information

NPI: 1093161655
Provider Name (Legal Business Name): JASON GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 GREEN PINE LN
VIRGINIA BEACH VA
23452-5902
US

IV. Provider business mailing address

3433 GREEN PINE LN
VIRGINIA BEACH VA
23452-5902
US

V. Phone/Fax

Practice location:
  • Phone: 757-689-7923
  • Fax: 718-682-3968
Mailing address:
  • Phone: 757-689-7923
  • Fax: 718-682-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number0101271206
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101271206
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: