Provider Demographics
NPI:1487619672
Name:GOLDBERG, DAVID LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:312-972-6432
Mailing Address - Fax:312-264-2554
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:312-972-6432
Practice Address - Fax:312-264-2554
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360866462084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry