Provider Demographics
NPI:1336134261
Name:GOLDFINE, STACEY MORGAN (DO)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MORGAN
Last Name:GOLDFINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S LYNNHAVEN RD STE 450
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-8524
Mailing Address - Country:US
Mailing Address - Phone:757-351-4585
Mailing Address - Fax:248-792-3927
Practice Address - Street 1:2901 S LYNNHAVEN RD STE 450
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-8524
Practice Address - Country:US
Practice Address - Phone:757-351-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017551207Q00000X, 2083P0500X
KS05-27916207Q00000X
VA0102207401207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1504041Medicare UPIN
MIMI1504Medicare PIN
MIMI1503041Medicare UPIN
MIMI1503Medicare PIN