Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 25MA03788500 | NJ |
Y | 207K00000X | Allergist & Immunologist | MD023998E | PA |
NPI | 1093863334 |
---|---|
Provider Name | Dr. Marc F Goldstein |
First Address | Philadelphia, PA 19107-1554 |
Second Address | Philadelphia, PA 19107-1554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 09/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D19600 | (02) |