Provider Demographics
NPI:1821169236
Name:GOLSHAN, NASRIN (MD)
Entity Type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:GOLSHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4434
Mailing Address - Country:US
Mailing Address - Phone:484-364-2824
Mailing Address - Fax:610-350-3099
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:STE 3
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4434
Practice Address - Country:US
Practice Address - Phone:484-364-2824
Practice Address - Fax:610-350-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037167L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1005736Medicaid
PA185922Medicare PIN
PAB40885Medicare UPIN