Individual
BRADLEY GOLDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15200 COMMUNITY RD, GULFPORT, MS 39503-3085
(228) 575-7022
(228) 575-7097
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
01070390A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
036074881
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
28322
MS
2080N0001X
Neonatal-Perinatal Medicine Physician
329609
LA
2080N0001X
Neonatal-Perinatal Medicine Physician
674
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001071268
ANTHEM PIN
IN
01
—
01070390A
IN STATE LICENSE
IN
01
—
01070390B
CSR
IN
05
—
036074881
—
IL
05
—
100098179
—
WI
05
—
1J4304
—
MS
05
—
1L7105
—
MS
Enumeration date
06/12/2006
Last updated
03/07/2023
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