Healthcare Provider Details

I. General information

NPI: 1326032178
Provider Name (Legal Business Name): STUART H GOLDSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 1ST ST NW STE 2
PULASKI VA
24301-5605
US

IV. Provider business mailing address

101 1ST ST NW STE 2
PULASKI VA
24301-5605
US

V. Phone/Fax

Practice location:
  • Phone: 540-509-5269
  • Fax: 540-980-0515
Mailing address:
  • Phone: 540-509-5269
  • Fax: 540-980-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102049996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: