Provider Demographics
NPI:1114370269
Name:GOLDSTEIN, CAROL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL LYNN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SENGEKONTACKET RD
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-7829
Mailing Address - Country:US
Mailing Address - Phone:598-696-6108
Mailing Address - Fax:
Practice Address - Street 1:19 SENGEKONTACKET RD
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-7829
Practice Address - Country:US
Practice Address - Phone:508-696-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease