Healthcare Provider Details

I. General information

NPI: 1083676266
Provider Name (Legal Business Name): ROBERT ADAM GOLDSTEEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4591 SOCASTEE BLVD
MYRTLE BEACH SC
29588-7209
US

IV. Provider business mailing address

PO BOX 3439
NORTH MYRTLE BEACH SC
29582-0439
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax: 866-778-9611
Mailing address:
  • Phone: 843-839-4447
  • Fax: 843-399-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO36721
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36721
License Number StateSC

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: