Provider Demographics
NPI:1952386419
Name:GOLDSTEIN, WARREN D (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:D
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 1:1011 N WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2466
Mailing Address - Country:US
Mailing Address - Phone:719-578-1162
Mailing Address - Fax:719-578-1462
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-5120
Practice Address - Fax:719-365-6860
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL86842085R0202X
CO246662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01246669Medicaid
D24486Medicare UPIN
COC811230Medicare PIN
CO01246669Medicaid
COCOA102066Medicare PIN