Provider Demographics
NPI:1902005028
Name:STUART GOLDSTEIN D.O. INC.
Entity Type:Organization
Organization Name:STUART GOLDSTEIN D.O. INC.
Other - Org Name:WHIPPLE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-324-0526
Mailing Address - Street 1:3731 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2933
Mailing Address - Country:US
Mailing Address - Phone:330-324-0526
Mailing Address - Fax:330-493-5680
Practice Address - Street 1:3731 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2933
Practice Address - Country:US
Practice Address - Phone:330-324-0526
Practice Address - Fax:330-493-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2610207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9917852OtherMEDICARE GROUP PROVIDER N