Healthcare Provider Details

I. General information

NPI: 1336415686
Provider Name (Legal Business Name): SHIRA GOLDSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRA GOLDSTEIN MD

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W LOMBARD ST
BALTIMORE MD
21201-1601
US

IV. Provider business mailing address

6410 FANNIN ST STE 230
HOUSTON TX
77030-3002
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-2233
  • Fax: 410-685-3142
Mailing address:
  • Phone: 832-325-6500
  • Fax: 713-512-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD455040
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0104807
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9217
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: