MEDICARE: DR. ROBERT JOEL GOLUB M.D.

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	207RC0000X	Cardiovascular Disease Physician	041848	CT

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	:	1851395651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOEL GOLUB M.D.

Provider Business Mailing Address
First Line	:	1062 BARNES RD
Second Line	:	STE 300
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2576
Country	:	US
Telephone Number	:	203-265-9831
Fax Number	:	203-265-2977

Provider Business Practice Location Address
First Line	:	1062 BARNES RD
Second Line	:	STE 300
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2576
Country	:	US
Telephone Number	:	203-265-9831
Fax Number	:	203-265-2977

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/28/2008

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