Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 35-086277 | OH |
NPI | 1265540033 |
---|---|
Provider Name | Laura D Goldberg |
First Address | Shaker Heights, OH 44122-5203 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000392985 | ANTHEM (01) | OH |
7325814 | AETNA (01) | OH |