Provider Demographics
NPI:1104063478
Name:DAVID S GOLDBERG MD INC
Entity type:Organization
Organization Name:DAVID S GOLDBERG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-649-3377
Mailing Address - Street 1:24591 SILVER CLOUD CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6549
Mailing Address - Country:US
Mailing Address - Phone:831-649-3377
Mailing Address - Fax:831-649-6725
Practice Address - Street 1:24591 SILVER CLOUD CT
Practice Address - Street 2:SUITE 150
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6549
Practice Address - Country:US
Practice Address - Phone:831-649-3377
Practice Address - Fax:831-649-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG085126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT037AMedicare PIN