Healthcare Provider Details

I. General information

NPI: 1114160298
Provider Name (Legal Business Name): BRIAN E GOLDWASSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LOGANS FERRY RD STE 2
LOWER BURRELL PA
15068-2048
US

IV. Provider business mailing address

125 LOGANS FERRY RD
NEW KENSINGTON PA
15068-2048
US

V. Phone/Fax

Practice location:
  • Phone: 249-944-7407
  • Fax: 724-994-4745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD436652
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD436652
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: