Provider Demographics
NPI:1073289922
Name:GOLD STAR MEDICAL LLC
Entity Type:Organization
Organization Name:GOLD STAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-673-1238
Mailing Address - Street 1:#184 CALLE VALENCIA
Mailing Address - Street 2:URB. LA SALAMANCA
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-673-1238
Mailing Address - Fax:
Practice Address - Street 1:2 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1750
Practice Address - Country:US
Practice Address - Phone:787-673-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR371248OtherREGISTER NUMBER