Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 155284 | MA |
NPI | 1023037660 |
---|---|
Provider Name | Michael Goldstein |
First Address | Lynn, MA 01904-1419 |
Second Address | Lynn, MA 01904-1419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101940 | (05) | MA |
H18339 | (02) | MA |