Provider Demographics
NPI:1811919228
Name:GOLDSTEIN, BENJAMIN M (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 LADUE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2056
Mailing Address - Country:US
Mailing Address - Phone:314-996-5900
Mailing Address - Fax:
Practice Address - Street 1:8888 LADUE RD STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-996-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110008424OtherRR MEDICARE
MO202630927Medicaid
MO110008424OtherRR MEDICARE
MO000001950Medicare PIN