Basic Information
| Provider Information | |||||||||
| NPI: | 1386662989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDENBERG | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 E HARVARD AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802107006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036493200 | ||||||||
| FaxNumber: | 3037653201 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 E HARVARD AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802107006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036493200 | ||||||||
| FaxNumber: | 3037653201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 03/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 42941 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 42941 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 58955313 | 05 | CO | MEDICAID |