Healthcare Provider Details

I. General information

NPI: 1386671089
Provider Name (Legal Business Name): CHARLES GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E DUNLAP AVE
PHOENIX AZ
85020-2825
US

IV. Provider business mailing address

4478 E MOCKINGBIRD LN
SCOTTSDALE AZ
85253-2400
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6353
  • Fax:
Mailing address:
  • Phone: 602-363-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number7002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: