Provider Demographics
NPI:1023125812
Name:GOLDBERG, DAPHNE M (MD)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 GLENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066
Mailing Address - Country:US
Mailing Address - Phone:610-667-7203
Mailing Address - Fax:610-667-0447
Practice Address - Street 1:18 HAVERFORD STATION RD.
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041
Practice Address - Country:US
Practice Address - Phone:610-880-8028
Practice Address - Fax:610-880-8023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD419130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH60294Medicare UPIN