Healthcare Provider Details

I. General information

NPI: 1346209731
Provider Name (Legal Business Name): RICHARD D. GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE SW411
BOSTON MA
02215-5418
US

IV. Provider business mailing address

450 BROOKLINE AVENUE SW411
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6637
  • Fax: 617-582-9148
Mailing address:
  • Phone: 617-632-6637
  • Fax: 617-582-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75599
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number75599
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: