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General NPI Number Information
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NPI Number | 1063454171
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Entity Type | Individual
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Provider Name | DAVID GOLDENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 3630 GUION RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46222-1616
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Country | US
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Telephone | 317-920-7139
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Fax |
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Provider Business Mailing Address
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Address Line | 6626E 75TH ST 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01023645
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License Number State | IN
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