MEDICARE: DR. NEIL GOLDBERG 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	174400000X	Specialist	160284	NY
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	2013-01786	NC
3	208100000X	Physical Medicine & Rehabilitation Physician	2013-01786	NC
4	2085R0202X	Diagnostic Radiology Physician	2013-01786	NC

General Provider Information

NPI Number	:	1780625509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL GOLDBERG MD

Provider Business Mailing Address
First Line	:	3535 RANDOLPH RD
Second Line	:	STE 208
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1082
Country	:	US
Telephone Number	:	704-442-9805
Fax Number	:	704-405-0868

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH RD
Second Line	:	STE 208
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1082
Country	:	US
Telephone Number	:	704-442-9805
Fax Number	:	704-405-0868

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	10/08/2021

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