Healthcare Provider Details

I. General information

NPI: 1447224027
Provider Name (Legal Business Name): ALVIN ISRAEL GOLDSTONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GLENSIDE DR
RICHMOND VA
23226-3769
US

IV. Provider business mailing address

1800 GLENSIDE DR
RICHMOND VA
23226-3769
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8308
  • Fax: 804-288-7562
Mailing address:
  • Phone: 804-288-8308
  • Fax: 804-288-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101019705
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: