Provider Demographics
NPI:1871561746
Name:GOLDBERG, TREVOR I (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:I
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25026207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36083OtherBCBS
NC4074100OtherAETNA
SCN25026Medicaid
SC20095443OtherSELECT HEALTH OF SC
SC776466OtherWELLCARE
NC1959OtherDOCTORS HEALTH PLAN
NC10479OtherKANAWHA
SC000000257626OtherUNISON HEALTH PLAN OF SC
NC0129451001OtherCIGNA
NC276569OtherMAMSI
NC6866OtherPARTNERS
NY1041431OtherUNITED HEATHCARE
NC11106OtherWELLPATH
NC8936083Medicaid
NC141009OtherCOVENTRY HEALTHCARE
NC24400OtherMEDCOST
NC141009OtherCOVENTRY HEALTHCARE
NC1959OtherDOCTORS HEALTH PLAN
SC776466OtherWELLCARE