Healthcare Provider Details

I. General information

NPI: 1750556791
Provider Name (Legal Business Name): RICHARD A. GOLDSTEIN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 RUIN CREEK RD SUITE 003
HENDERSON NC
27536-5921
US

IV. Provider business mailing address

568 RUIN CREEK RD SUITE 003
HENDERSON NC
27536-5921
US

V. Phone/Fax

Practice location:
  • Phone: 252-492-5600
  • Fax: 252-492-5685
Mailing address:
  • Phone: 252-492-5600
  • Fax: 252-492-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4578
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number93-00478
License Number StateNC

VIII. Authorized Official

Name: DR. RICHARD A. GOLDSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 252-492-5600