Provider Demographics
NPI:1366412314
Name:GOLDBERG, SHARON R (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4230
Mailing Address - Country:US
Mailing Address - Phone:805-687-5500
Mailing Address - Fax:805-682-3295
Practice Address - Street 1:510 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4230
Practice Address - Country:US
Practice Address - Phone:805-687-5500
Practice Address - Fax:805-682-3295
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52960207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001380386Medicaid
CTG97932Medicare UPIN
CT160001799Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID