Provider Demographics
NPI:1154701019
Name:GOLDBACH, HAYLEY (MD)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:GOLDBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA 9NW ROOM 55
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:AMBULATORY PATIENT CENTER APC 10
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4626
Practice Address - Country:US
Practice Address - Phone:401-444-7959
Practice Address - Fax:401-444-7144
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT208181208000000X
RIMD17221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics