Healthcare Provider Details

I. General information

NPI: 1144269457
Provider Name (Legal Business Name): STEVEN J GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 THOMAS JONES WAY SUITE 200
EXTON PA
19341-2553
US

IV. Provider business mailing address

PO BOX 350
SELLERSVILLE PA
18960-0350
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6755
  • Fax: 610-647-2063
Mailing address:
  • Phone: 215-723-2333
  • Fax: 215-723-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD019159E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00351306
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier0008387270004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: