Active NPI
Mark A Goldberg, MD
- Diagnostic Radiology Physician
- Waltham, MA
National Provider Identifier
1013994888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 73724
- Practice address
- 271 Waverly Oaks Rd
Waltham, MA 02452-8469 - Phone
- (781) 622-2345
- Fax
- (781) 622-2333
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 73724 | MA | Primary |
Addresses
Primary practice location
271 Waverly Oaks Rd
Waltham, MA 02452-8469
Mailing address
26 Slocum Rd
Lexington, MA 02421-5622
Phone (781) 863-2247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73724 | MA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563408000000",
"number": "1013994888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 SLOCUM RD",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024215622",
"telephone_number": "781-863-2247",
"fax_number": "781-861-9862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "271 WAVERLY OAKS RD",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024528469",
"telephone_number": "781-622-2345",
"fax_number": "781-622-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "MARK",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2019-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MA",
"license": "73724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.