MEDICARE: DR. ELSA T GOLDSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	C1-0010776	DE

General Provider Information

NPI Number	:	1508868696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELSA T GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	36502 WARWICK DR
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-1320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36502 WARWICK DR
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-1320
Country	:	US
Telephone Number	:	302-503-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/28/2022

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