Basic Information
| Provider Information | |||||||||
| NPI: | 1831179514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDENBERG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ARLIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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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 | 207YX0901X | 35034453 | OH | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
ID Information
| ID | Type | State | Issuer | Description | 311777214 | 01 | COVENTANT FAMILY | OTHER | 0297692 | 01 | BCMH | OTHER | 311777214 | 01 | AARP | OTHER | 50217 | 01 | HEALTHSOURCE | OTHER | 0297692 | 05 | OH | MEDICAID | 1000560 | 01 | EVERCARE | OTHER | D3445303 | 01 | HUMANA CHOICE CARE | OTHER | 311777214 | 01 | DIRECT CARE AMERICA | OTHER | 311777214 | 01 | FIRST HEALTH | OTHER | 000000211218 | 01 | ANTHEM | OTHER | 100302 | 01 | DAYMED | OTHER | 2597202 | 01 | AETNA | OTHER | 311777214 | 01 | CIGNA | OTHER | 311777214 | 01 | CREATIVE HEALTH | OTHER | 311777214030 | 01 | CARESOURCE | OTHER | 311777214 | 01 | GEHA | OTHER | 311777214 | 01 | HEALTH SERVICES PREFERRED | OTHER |