Provider Demographics
NPI:1023514759
Name:GOODSTEIN, TAYLOR ALEXANDRA (MD)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:ALEXANDRA
Last Name:GOODSTEIN
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 1:367 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2285
Mailing Address - Country:US
Mailing Address - Phone:970-319-1255
Mailing Address - Fax:
Practice Address - Street 1:915 OLENTANGY RIVER RD STE 2000
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3159
Practice Address - Country:US
Practice Address - Phone:614-293-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98552208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program