Provider Demographics
NPI:1417948431
Name:GOLDSTEIN, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1233
Mailing Address - Country:US
Mailing Address - Phone:215-741-4910
Mailing Address - Fax:215-741-4394
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1233
Practice Address - Country:US
Practice Address - Phone:215-741-4910
Practice Address - Fax:215-741-4394
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030637E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001295681Medicaid
PAC27872Medicare UPIN
PA001295681Medicaid