Provider Demographics
NPI:1831288554
Name:GOLDSTEIN, BERNARD (PA)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13615 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4607
Mailing Address - Country:US
Mailing Address - Phone:813-972-3338
Mailing Address - Fax:813-977-9070
Practice Address - Street 1:13615 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4607
Practice Address - Country:US
Practice Address - Phone:813-972-3338
Practice Address - Fax:813-977-9070
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0000369213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480014804OtherRAILROAD MEDICARE
FLCG3347OtherRAILROAD MEDICARE
FL591305394OtherTAX ID
FL0867240001OtherPTAN/DME#
FL029739900Medicaid
FLCG3347OtherRAILROAD MEDICARE
FL029739900Medicaid