Provider Demographics
NPI:1194706838
Name:GOLDBACH, NORMAN J (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:GOLDBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 SW CARY PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5600
Mailing Address - Country:US
Mailing Address - Phone:919-863-9441
Mailing Address - Fax:919-863-9442
Practice Address - Street 1:1904 S MAIN ST STE 114
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5030
Practice Address - Country:US
Practice Address - Phone:919-554-8539
Practice Address - Fax:919-554-9686
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-060154G208800000X
IN01043533A208800000X
NC2007-00855208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200022490Medicaid
IN340009455OtherTRAVELERS
IN000000111097OtherANTHEM
OH0114192Medicaid
OH0776281Medicare ID - Type Unspecified
IN340009455OtherTRAVELERS
IN200022490Medicaid