Provider Demographics
NPI:1174905996
Name:GOLDEN, CARLEIGH B (MD)
Entity type:Individual
Prefix:
First Name:CARLEIGH
Middle Name:B
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLEIGH
Other - Middle Name:B
Other - Last Name:KOENCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5002 UNDERWOOD AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2236
Mailing Address - Country:US
Mailing Address - Phone:402-717-0785
Mailing Address - Fax:402-717-4905
Practice Address - Street 1:5002 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132
Practice Address - Country:US
Practice Address - Phone:402-717-0785
Practice Address - Fax:402-717-4905
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7479207R00000X
NE30613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine