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General NPI Number Information
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NPI Number | 1366498636
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Entity Type | Individual
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Provider Name | MARK GOLDBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 36001 EUCLID AVE SUITE B-6
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4643
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Country | US
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Telephone | 440-953-2500
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Fax | 440-953-2772
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Provider Business Mailing Address
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Address Line | PO BOX 74913
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City | CLEVELAND
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State | OH
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Zip | 44194-0996
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Country | US
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Telephone | 216-383-6480
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Fax | 216-383-6745
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35-085145
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License Number State | OH
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