| Doctor Name: | MARK A GOLDBERG |
| NPI Number: | 1013994888 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 73724 |
| Business Practice Address: | 200 West St Waltham, MA - 024511121 |
| Business Phone Number: | 7814345125 |
| Business Fax Number: | 7817685518 |
| Mailing Address: | 1 Carmel Cir, LEXINGTON |
| State: | MA |
| Postal Code: | 024216804 |
| Phone Number: | 7818632247 |
| Fax Number: | 7818619862 |
| NPI Enumeration Date: | 12/22/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 73724 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |