Provider Demographics
NPI:1831119544
Name:GOLDSTEIN, DAVID W (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416210
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6210
Mailing Address - Country:US
Mailing Address - Phone:856-616-8600
Mailing Address - Fax:856-616-8601
Practice Address - Street 1:2080 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1202
Practice Address - Country:US
Practice Address - Phone:856-616-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007587L2085R0204X
NJMB46502392085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001666135Medicaid
NJ6608205Medicaid
NJ6608205Medicaid