Healthcare Provider Details

I. General information

NPI: 1568844439
Provider Name (Legal Business Name): AMY GOLDSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST STE 201
LOVELAND CO
80538-8939
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7165
  • Fax: 970-203-7105
Mailing address:
  • Phone: 970-624-2409
  • Fax: 970-490-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30601
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0066363
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: