Provider Demographics
NPI:1780612630
Name:GOLDSTEIN, MARC SOLOMON (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:SOLOMON
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18 MCGILPIN RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1230
Mailing Address - Country:US
Mailing Address - Phone:508-347-2456
Mailing Address - Fax:
Practice Address - Street 1:605 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1901
Practice Address - Country:US
Practice Address - Phone:508-856-0104
Practice Address - Fax:508-853-4961
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA39815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17676000515OtherCIGNA
MA6191797Medicaid
MAE58003OtherBLUE SHIELD
MAB73983Medicare UPIN