Basic Information
| Provider Information | |||||||||
| NPI: | 1740262641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | PINKUS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2227 | ||||||||
| Address2: | |||||||||
| City: | SKYLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287762227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752644 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 3266 N MERIDIAN ST | ||||||||
| Address2: | # 900 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462085846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179248297 | ||||||||
| FaxNumber: | 3179248239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 11/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 01033874A | IN | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | DE8663 | 01 | RAILROAD MEDICARE GROUP | OTHER | P00321189 | 01 | RAILROAD MEDICARE | OTHER | 000000081331 | 01 | IN | MC BC/BS | OTHER | 01033874A | 05 | IN | MEDICAID | IN1125004 | 01 | IN | MEDICARE PTAN | OTHER | IN1126004 | 01 | IN | MEDICARE PTAN | OTHER | 200809930 | 05 | IN | MEDICAID | 000000475815 | 01 | IN | AACI BC/BS PIN NUMBER | OTHER | IN1127004 | 01 | IN | MEDICARE PTAN | OTHER |