MEDICARE: JOEL SAMUEL GOLDBERG DO

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	207Q00000X	Family Medicine Physician	OS004415L	PA

General Provider Information

NPI Number	:	1699714402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL SAMUEL GOLDBERG DO

Provider Business Mailing Address
First Line	:	4015 CHICHESTER AVE
Second Line	:
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-3138
Country	:	US
Telephone Number	:	610-494-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 CHICHESTER AVE
Second Line	:
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-3138
Country	:	US
Telephone Number	:	610-494-4422
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/04/2026

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