Provider Demographics
NPI:1649256041
Name:GOLDSTEIN, CHARLES (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4535 S KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1139
Mailing Address - Country:US
Mailing Address - Phone:303-973-0798
Mailing Address - Fax:303-973-0314
Practice Address - Street 1:4535 S KIPLING ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-1139
Practice Address - Country:US
Practice Address - Phone:303-973-0798
Practice Address - Fax:303-973-0314
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO18797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01187970Medicaid
COCK7018Medicare PIN