Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN1857596 | MA |
Y | 213EG0000X | General Practice | DN1857596 | MA |
NPI | 1003338575 |
---|---|
Provider Name | Dr. Lacrima M Goldberg |
First Address | Madison, WI 53703-3766 |
Second Address | Madison, WI 53714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 07/08/2018 |