Provider Demographics
NPI:1104138403
Name:GOLDBERG, JASON LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:GOLDBERG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 E MARKET ST STE 20
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-5123
Mailing Address - Country:US
Mailing Address - Phone:717-244-8504
Mailing Address - Fax:
Practice Address - Street 1:4075 E MARKET ST STE 20
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-5123
Practice Address - Country:US
Practice Address - Phone:717-244-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027862010003Medicaid
PA268363Medicare PIN