Provider Demographics
NPI:1558339721
Name:GOLDSTEIN, LEWIS WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:WILLIAM
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 1:653 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501
Mailing Address - Country:US
Mailing Address - Phone:843-317-6600
Mailing Address - Fax:843-317-9259
Practice Address - Street 1:653 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-317-6600
Practice Address - Fax:843-317-9259
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256714207V00000X
SC11090207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC608200281OtherMCARE GROUP
SCGP0983110906Medicaid