MEDICARE: DR. DAVID TODD 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	207W00000X	Ophthalmology Physician	41482	AZ
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	41482	AZ

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	:	1417170432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TODD GOLDENBERG MD

Provider Business Mailing Address
First Line	:	3303 E BASELINE RD STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-534-7333
Fax Number	:	480-534-7333

Provider Business Practice Location Address
First Line	:	3303 E BASELINE RD STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-534-7333
Fax Number	:	480-534-7333

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	01/30/2026

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