Basic Information
| Provider Information | |||||||||
| NPI: | 1629028238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2876 GUARDIAN LANE | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234527327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574635240 | ||||||||
| FaxNumber: | 7574636572 | ||||||||
| Practice Location | |||||||||
| Address1: | 3235 ACADEMY AVE | ||||||||
| Address2: | STE 305 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237033200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576869300 | ||||||||
| FaxNumber: | 7576861514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0600X | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 283422 | 01 | VA | MPIPA OPTIMA CHOICE | OTHER | 063EG | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 7114486 | 05 | VA | MEDICAID | 0500484 | 01 | VA | UNITED HEALTHCARE | OTHER | 31253 | 01 | VA | SENTARA | OTHER | 89063EG | 05 | NC | MEDICAID | 283422 | 01 | VA | ALLIANCE MAMSI | OTHER | 317408 | 01 | VA | ANTHEM | OTHER |