Provider Demographics
NPI:1053339341
Name:GOLDBERG, HARVEY E (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:E
Last Name:GOLDBERG
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 1:777 TOWNSHIP LINE ROAD
Mailing Address - Street 2:,SUITE 200
Mailing Address - City:YARDLEY,
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-860-0775
Mailing Address - Fax:215-615-0500
Practice Address - Street 1:777 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5552
Practice Address - Country:US
Practice Address - Phone:215-860-0775
Practice Address - Fax:215-860-4394
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013424E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000639680Medicaid
PAC30203Medicare UPIN
PA105396Medicare PIN