Provider Demographics
NPI:1164416822
Name:GOLDSTEIN, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GOLDSTEIN
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:PO BOX 660024
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0024
Mailing Address - Country:US
Mailing Address - Phone:610-789-8070
Mailing Address - Fax:610-789-9937
Practice Address - Street 1:2010 OLD WEST CHESTER PIKE
Practice Address - Street 2:SUITE 330
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2712
Practice Address - Country:US
Practice Address - Phone:610-789-8070
Practice Address - Fax:610-789-9937
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027057E207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097961U0UOtherMEDICARE
PAMD027057EOtherLICENSE FOR PA
DE00B064H14OtherMEDICARE
NJ097961U0UOtherMEDICARE
PA073034H12Medicare PIN
PA073034Q01Medicare PIN