Basic Information
| Provider Information | |||||||||
| NPI: | 1871561746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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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 | 207Y00000X | 25026 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 36083 | 01 | NC | BCBS | OTHER | 4074100 | 01 | NC | AETNA | OTHER | N25026 | 05 | SC | MEDICAID | 20095443 | 01 | SC | SELECT HEALTH OF SC | OTHER | 776466 | 01 | SC | WELLCARE | OTHER | 1959 | 01 | NC | DOCTORS HEALTH PLAN | OTHER | 10479 | 01 | NC | KANAWHA | OTHER | 000000257626 | 01 | SC | UNISON HEALTH PLAN OF SC | OTHER | 0129451001 | 01 | NC | CIGNA | OTHER | 276569 | 01 | NC | MAMSI | OTHER | 6866 | 01 | NC | PARTNERS | OTHER | 1041431 | 01 | NY | UNITED HEATHCARE | OTHER | 11106 | 01 | NC | WELLPATH | OTHER | 8936083 | 05 | NC | MEDICAID | 141009 | 01 | NC | COVENTRY HEALTHCARE | OTHER | 24400 | 01 | NC | MEDCOST | OTHER |