Provider Demographics
NPI:1306815857
Name:GOLDPIN, STEPHANIE I (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:I
Last Name:GOLDPIN
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 1:22 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5030
Mailing Address - Country:US
Mailing Address - Phone:203-356-1404
Mailing Address - Fax:203-232-0901
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5030
Practice Address - Country:US
Practice Address - Phone:203-356-1404
Practice Address - Fax:203-232-0901
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE02268Medicare UPIN