Healthcare Provider Details

I. General information

NPI: 1790723666
Provider Name (Legal Business Name): HELEN LAURA GOLDBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-7878
  • Fax: 360-414-7876
Mailing address:
  • Phone: 970-399-2895
  • Fax: 970-874-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberJ9059
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberDR0032488
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD61103919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: