Provider Demographics
NPI:1790002897
Name:MARVIN R. GOLDSTEIN, MD, LTD
Entity Type:Organization
Organization Name:MARVIN R. GOLDSTEIN, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-949-9829
Mailing Address - Street 1:7331 E OSBORN DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6435
Mailing Address - Country:US
Mailing Address - Phone:480-949-9429
Mailing Address - Fax:480-949-2413
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:SUITE 440
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-949-9429
Practice Address - Fax:480-949-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0028770OtherBC ID
AZAZ0028770OtherBC ID