Healthcare Provider Details

I. General information

NPI: 1508969445
Provider Name (Legal Business Name): LAWRENCE P GOLDSTICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ELIZABETH PLACE SUITE 210 WEST MEDICAL PLAZA
DAYTON OH
45408
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 937-495-0000
  • Fax: 937-495-0140
Mailing address:
  • Phone: 513-585-5504
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35051165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: