Provider Demographics
NPI:1932224995
Name:GORENBERG, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GORENBERG
Suffix:
Gender:M
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-0428
Mailing Address - Country:US
Mailing Address - Phone:508-693-8892
Mailing Address - Fax:508-693-9091
Practice Address - Street 1:354 GIFFORD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2950
Practice Address - Country:US
Practice Address - Phone:508-693-8892
Practice Address - Fax:508-693-9091
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA359342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA33585Medicare UPIN
MAB11438Medicare ID - Type Unspecified