Healthcare Provider Details

I. General information

NPI: 1750474433
Provider Name (Legal Business Name): DAVID MEYER GOLDSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BROOKTREE ROAD SUITE 300
WEXFORD PA
15090-9278
US

IV. Provider business mailing address

2500 BROOKTREE ROAD SUITE 300
WEXFORD PA
15090-9278
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-7780
  • Fax: 724-934-7779
Mailing address:
  • Phone: 724-934-7780
  • Fax: 724-934-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD033446E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1073629
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: