MEDICARE: SCOTT M 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	207Q00000X	Family Medicine Physician	264518	MA
2	207Q00000X	Family Medicine Physician	0101272335	VA

General Provider Information

NPI Number	:	1952797425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT M GOLDBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 79777
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-0777
Country	:	US
Telephone Number	:	434-654-7794
Fax Number	:	434-975-1834

Provider Business Practice Location Address
First Line	:	29 JEFFERSON CT
Second Line	:
City	:	ZION CROSSROADS
State	:	VA
Zip	:	22942-9602
Country	:	US
Telephone Number	:	434-654-8900
Fax Number	:	844-527-9358

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

Provider Enumeration Date	:	04/12/2015
Last Update Date	:	07/27/2021

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