Provider Demographics
NPI:1700920386
Name:CHARLES GOLDSTEIN PC
Entity Type:Organization
Organization Name:CHARLES GOLDSTEIN PC
Other - Org Name:LAKEHURST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-973-0798
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18797208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28856546Medicaid
CO75424OtherLAKEHURST MEDICAL CENTER
CO28856546Medicaid