Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 32462 | MN |
Y | 208000000X | Pediatrician | 32462 | MN |
NPI | 1770890774 |
---|---|
Provider Name | Maryann Goldstein |
First Address | Edina, MN 55436-1313 |
Second Address | Edina, MN 55436-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2010 |
Last Update Date | 12/09/2010 |