Provider Demographics
NPI:1821721978
Name:GOLDSTAR MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:GOLDSTAR MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASOZI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:781-661-8969
Mailing Address - Street 1:164 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4423
Mailing Address - Country:US
Mailing Address - Phone:781-661-8969
Mailing Address - Fax:781-723-2557
Practice Address - Street 1:164 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4423
Practice Address - Country:US
Practice Address - Phone:339-224-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty