Provider Demographics
NPI:1710947247
Name:GOLDSTEIN, MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
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 1:9880 BUSTLETON AVE STE 332
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2144
Mailing Address - Country:US
Mailing Address - Phone:215-827-1570
Mailing Address - Fax:215-827-1571
Practice Address - Street 1:9880 BUSTLETON AVE
Practice Address - Street 2:SUITE 332
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2185
Practice Address - Country:US
Practice Address - Phone:215-827-1570
Practice Address - Fax:215-827-1571
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-074027-L207RH0003X
PAMD074027L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101108164Medicaid
I11641Medicare UPIN
PA101108164Medicaid