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NPI Code Detail

MEDICARE: DAVID D GOLDBERG D.O.

MEDICARE: DAVID D GOLDBERG D.O.
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
1207Q00000XFamily Medicine Physician34-00-2116GOH
2207QA0401XAddiction Medicine (Family Medicine) Physician34-00-2116GOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000226414OTHEROHANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578563128
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID D GOLDBERG D.O.
Provider Business Mailing Address
First Line : 3033 KETTERING BLVD
Second Line : SUITE 100
City : MORAINE
State : OH
Zip : 45439-1962
Country : US
Telephone Number : 937-293-2133
Fax Number : 937-293-2161
Provider Business Practice Location Address
First Line : 3033 KETTERING BLVD
Second Line : SUITE 100
City : MORAINE
State : OH
Zip : 45439-1962
Country : US
Telephone Number : 937-293-2133
Fax Number : 937-293-2161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 08/16/2011

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Practice Fax: 937-293-2161

Directions to “ DAVID D GOLDBERG D.O.” Practice Location

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