Healthcare Provider Details

I. General information

NPI: 1497757462
Provider Name (Legal Business Name): ADAM SETH GOLDSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR STE 200
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

2211 CHAPEL AVE W STE 301
CHERRY HILL NJ
08002-2062
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-7280
  • Fax:
Mailing address:
  • Phone: 856-665-2017
  • Fax: 856-488-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB07740400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: