Healthcare Provider Details

I. General information

NPI: 1992409627
Provider Name (Legal Business Name): BRYAN GOLDSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 MITSCHER AVE STE 250
NORFOLK VA
23551-0001
US

IV. Provider business mailing address

152 MITSCHER AVE SUITE 250
NORFOLK VA
23551-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208760
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: