Provider Demographics
NPI:1730128539
Name:GOLDSTEIN, JEREMIAH (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
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 1:3601 A ST
Mailing Address - Street 2:ST. CHRISTOPER'S HOSPITAL FOR CHILDREN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1043
Mailing Address - Country:US
Mailing Address - Phone:215-427-8362
Mailing Address - Fax:215-427-4317
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:ST. CHRISTOPER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-8362
Practice Address - Fax:215-427-4317
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054922L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01558675Medicaid
PA1496278Medicare ID - Type Unspecified
PA01558675Medicaid