Provider Demographics
NPI:1700895109
Name:GOLDSTEIN, PHILIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:207 N. BROAD STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:610-279-7696
Mailing Address - Fax:610-279-7782
Practice Address - Street 1:676 DEKALB PIKE
Practice Address - Street 2:SUITE 106
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422
Practice Address - Country:US
Practice Address - Phone:610-279-7696
Practice Address - Fax:610-279-7782
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035233E207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001670871 0005Medicaid
PA103990GT6Medicare PIN