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Contact Information

BRADLEY GOLDENBERG, MD
15200 COMMUNITY RD
GULFPORT, MS39503-3085
 Phone: 228-575-7022
 Fax: 228-575-7097
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neonatal-Perinatal Medicine

2080N0001X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for BRADLEY GOLDENBERG · (Male)

NPI # 1477595239
Status Active
Credentials MD
Entity Individual
Enumeration date 06/12/2006
Last updated 03/07/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036074881
  • IN License # 01070390A
  • LA License # 329609
  • MS License # 28322
  • WI License # 674
  • IL Medicaid 036074881
  • MS Medicaid 1J4304
  • MS Medicaid 1L7105
  • WI Medicaid 100098179
  • IN Other 000001071268 ANTHEM PIN
  • IN Other 01070390B CSR
  • IN Other 01070390A IN STATE LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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