Provider Demographics
NPI:1285661413
Name:GOLDSTEIN, LAWRENCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
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 1:501 MARSHALL ST
Mailing Address - Street 2:STE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-354-0869
Mailing Address - Fax:601-352-6521
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:STE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1687
Practice Address - Country:US
Practice Address - Phone:601-354-0869
Practice Address - Fax:601-352-6521
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6409207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014887Medicaid
160000400Medicare ID - Type Unspecified
D80648Medicare UPIN