Basic Information
| Provider Information | |||||||||
| NPI: | 1073595518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 MARYLAND RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158308700 | ||||||||
| FaxNumber: | 2158308715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 MARYLAND RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158308700 | ||||||||
| FaxNumber: | 2158308715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OS006254L | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.