MEDICARE: DR. SUSAN T GOLDSTEIN MD

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	207RI0200X	Infectious Disease Physician	5622792	NY

General Provider Information

NPI Number	:	1750484606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN T GOLDSTEIN MD

Provider Business Mailing Address
First Line	:	1156 PIEDMONT AVE NE
Second Line	:	APT C5
City	:	ATLANTA
State	:	GA
Zip	:	30309-3774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 PIEDMONT AVE NE
Second Line	:	APT C5
City	:	ATLANTA
State	:	GA
Zip	:	30309-3774
Country	:	US
Telephone Number	:	404-607-0430
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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