Provider Demographics
NPI:1891847133
Name:GOLDSBY, CHERUBIM ELRETTA (MD)
Entity type:Individual
Prefix:DR
First Name:CHERUBIM
Middle Name:ELRETTA
Last Name:GOLDSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERUBIM
Other - Middle Name:ELRETTA
Other - Last Name:GOLDSBY-MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:513 BAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-436-2300
Mailing Address - Fax:757-436-2303
Practice Address - Street 1:513 BAYLOR CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-436-2300
Practice Address - Fax:757-436-2303
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242994208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203289038Medicaid