1255396198 NPI number — DR. RICHARD A GOLDSTEIN MD

Table of content: DR. RICHARD A GOLDSTEIN MD (NPI 1255396198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255396198 NPI number — DR. RICHARD A GOLDSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSTEIN
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255396198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
857 S BECKFORD DR
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27536-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-492-5600
Provider Business Mailing Address Fax Number:
252-492-5685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
857 S BECKFORD DR
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-3486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-492-5600
Provider Business Practice Location Address Fax Number:
252-492-5685
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  93-00478 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040007095 . This is a "040007095" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561844153 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000230578 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 127333 . This is a "WELLPATH SELECT, INC." identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8936132 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192218205207 . This is a "HUMANA CLAIMS OFFICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 36132 . This is a "BCBS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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