Provider Demographics
NPI:1124008693
Name:GOLDSTEIN, BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3455 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1142
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-732-6534
Practice Address - Street 1:8 ATWOOD DR
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4272
Practice Address - Country:US
Practice Address - Phone:413-586-5798
Practice Address - Fax:413-585-0587
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-06-26
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Provider Licenses
StateLicense IDTaxonomies
MA41324207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12682OtherHEALTH NEW ENGLAND
MA732894OtherCONNECTICARE
MA8126590OtherCIGNA
MAG14107OtherBLUE CROSS AND BLUE SHIELD
MA716917OtherTUFTS
MA732894OtherCONNECTICARE
MAB74059Medicare UPIN