BRADLEY GOLDENBERG MD NPI 1477595239

NPI Information

NPI: 1477595239
Provider Name: BRADLEY GOLDENBERG, MD
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
15200 COMMUNITY RD
GULFPORT, MS
ZIP 39503
Phone: (228) 575-7022
Get Directions

Bradley Goldenberg, MD is a neonatal-perinatal medicine pediatrics in Gulfport, MS. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. Bradley Goldenberg, MD NPI is 1477595239. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15200 COMMUNITY RD
GULFPORT, MS
ZIP 39503-085
Phone: (228) 575-7022
Fax: (228) 575-7097

The NPI 1477595239 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/12/2006 and was last updated on 2/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	01070390A	INDIANA	No
2	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	674	WISCONSIN	No
3	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	329609	LOUISIANA	No
4	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	036074881	ILLINOIS	No
5	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	28322	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01070390B	OTHER	INDIANA	CSR
2	01070390A	OTHER	INDIANA	IN STATE LICENSE
3	1J4304	MEDICAID	MISSISSIPPI
4	1L7105	MEDICAID	MISSISSIPPI
5	FG3419327	OTHER	INDIANA	DEA
6	000001071268	OTHER	INDIANA	ANTHEM PIN
7	100098179	MEDICAID	WISCONSIN
8	036074881	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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