Provider Demographics
NPI:1396796330
Name:GOLDENBERG, NAILA M (MD)
Entity type:Individual
Prefix:
First Name:NAILA
Middle Name:M
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 READING RD STE N
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2654
Mailing Address - Country:US
Mailing Address - Phone:513-604-1004
Mailing Address - Fax:513-437-0571
Practice Address - Street 1:969 READING RD STE N
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2654
Practice Address - Country:US
Practice Address - Phone:513-604-1004
Practice Address - Fax:513-437-0571
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079737207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100045840Medicaid
OH2757360Medicaid
IN200871830Medicaid
MI4919959Medicaid
MII46328Medicare UPIN
KY7100045840Medicaid