Provider Demographics
NPI:1346209731
Name:GOLDSTEIN, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVENUE
Mailing Address - Street 2:SW411
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-632-6637
Mailing Address - Fax:617-582-9148
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:SW411
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-6637
Practice Address - Fax:617-582-9148
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA75599208000000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97292Medicare UPIN