Provider Demographics
NPI:1114160298
Name:GOLDWASSER, BRIAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LOGANS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 LOGANS FERRY RD STE 2
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-2048
Practice Address - Country:US
Practice Address - Phone:249-944-7407
Practice Address - Fax:724-994-4745
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436652208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102290092Medicaid
PA1581403OtherGATEWAY
PAP00732031OtherRR MEDICARE
PA2103533OtherHIGHMARK
PA413063OtherUPMC
PA9768357OtherAETNA
PA102290092Medicaid