Healthcare Provider Details

I. General information

NPI: 1780056853
Provider Name (Legal Business Name): ANDREW ROBERT GOLDSTEIN MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-0534
  • Fax: 409-266-7846
Mailing address:
  • Phone: 409-772-0534
  • Fax: 409-772-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10101
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: