Healthcare Provider Details

I. General information

NPI: 1891285151
Provider Name (Legal Business Name): DAVID WILLIAM GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

110 BEVERLY ST APT 633
BOSTON MA
02114-2257
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-0596
  • Fax:
Mailing address:
  • Phone: 774-270-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number286817
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number286817
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: