Provider Demographics
NPI:1164472593
Name:GOLDSTEIN, JENNIFER PRICE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PRICE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:35 HOPE DR
Practice Address - Street 2:STE 104
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2086
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-2034
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074026L208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018652820001Medicaid
H47806Medicare UPIN
PA50754Medicare ID - Type Unspecified