MEDICARE: JILL D GOLDENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	42941	CO
2	207R00000X	Internal Medicine Physician	42941	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386662989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL D GOLDENBERG MD

Provider Business Mailing Address
First Line	:	950 E HARVARD AVE
Second Line	:	STE 200
City	:	DENVER
State	:	CO
Zip	:	80210-7006
Country	:	US
Telephone Number	:	303-649-3200
Fax Number	:	303-765-3201

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE
Second Line	:	STE 200
City	:	DENVER
State	:	CO
Zip	:	80210-7006
Country	:	US
Telephone Number	:	303-649-3200
Fax Number	:	303-765-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/03/2017

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