Healthcare Provider Details

I. General information

NPI: 1043505738
Provider Name (Legal Business Name): ROBERT NEIL GOLDSTONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2000
  • Fax:
Mailing address:
  • Phone: 617-726-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number261812
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: