Basic Information
| Provider Information | |||||||||
| NPI: | 1154701019 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOLDBACH | ||||||||
| FirstName: | HAYLEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 CIVIC CENTER BLVD | ||||||||
| Address2: | THE CHILDREN'S HOSPITAL OF PHILADELPHIA 9NW ROOM 55 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044319 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 593 EDDY STREET | ||||||||
| Address2: | AMBULATORY PATIENT CENTER APC 10 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014447959 | ||||||||
| FaxNumber: | 4014447144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT208181 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207N00000X | MD17221 | RI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.