Provider Demographics
NPI:1326032178
Name:GOLDSTEIN, STUART H (DO)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:H
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 1ST ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5605
Mailing Address - Country:US
Mailing Address - Phone:540-509-5269
Mailing Address - Fax:540-980-0515
Practice Address - Street 1:101 1ST ST NW STE 2
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5605
Practice Address - Country:US
Practice Address - Phone:540-509-5269
Practice Address - Fax:540-980-0515
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049996208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010159199Medicaid
VA00W400S01Medicare ID - Type Unspecified
VAP00262299Medicare PIN