Healthcare Provider Details

I. General information

NPI: 1821721978
Provider Name (Legal Business Name): GOLDSTAR MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WEBSTER ST
MALDEN MA
02148-4423
US

IV. Provider business mailing address

164 WEBSTER ST
MALDEN MA
02148-4423
US

V. Phone/Fax

Practice location:
  • Phone: 339-224-0961
  • Fax:
Mailing address:
  • Phone: 781-661-8969
  • Fax: 781-723-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. HARRIET J. KASOZI
Title or Position: CO-WORKER
Credential: NP
Phone: 781-661-8969