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General NPI Number Information
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NPI Number | 1477595239
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Entity Type | Individual
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Provider Name | BRADLEY GOLDENBERG MD
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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 | 03/07/2023
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Provider Practice Location Address
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Address Line | 15200 COMMUNITY RD
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City | GULFPORT
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State | MS
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Zip | 39503-3085
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Country | US
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Telephone | 228-575-7022
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Fax | 228-575-7097
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Provider Business Mailing Address
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Address Line | 2101 HIGHWAY 90
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City | GAUTIER
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State | MS
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Zip | 39553-5340
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Country | US
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Telephone | 228-497-7576
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Fax | 228-497-8869
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01070390A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 674
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 329609
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 036074881
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 28322
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License Number State | MS
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