Provider Demographics
NPI:1447204631
Name:GOLDSTEIN, HEATHER (PA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3201
Mailing Address - Country:US
Mailing Address - Phone:910-962-3280
Mailing Address - Fax:910-392-4130
Practice Address - Street 1:601 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3201
Practice Address - Country:US
Practice Address - Phone:910-962-3280
Practice Address - Fax:910-392-4130
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP46990Medicare UPIN
NC241124Medicare ID - Type Unspecified