Healthcare Provider Details

I. General information

NPI: 1144249749
Provider Name (Legal Business Name): STAFFORD S GOLDSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD SUITE #107
ANNANDALE VA
22003-1229
US

IV. Provider business mailing address

3301 WOODBURN RD SUITE #107
ANNANDALE VA
22003-1229
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-0437
  • Fax: 703-876-0722
Mailing address:
  • Phone: 703-876-0437
  • Fax: 703-876-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101030021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: