Provider Demographics
NPI:1346369782
Name:GOLDSTEIN, KATHLEEN (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GOLDSTEIN
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 1:1645 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2554
Mailing Address - Country:US
Mailing Address - Phone:540-552-1246
Mailing Address - Fax:540-552-1247
Practice Address - Street 1:1645 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2554
Practice Address - Country:US
Practice Address - Phone:540-552-1246
Practice Address - Fax:540-552-1247
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005559L207Q00000X
VA0102202911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine