Goldstein, Mark Allan
Goldstein, Mark Allan is an individual health care provider with primary practice located at 55 Fruit St Yaw 6C Pediatric Group Practice, Boston MA 02114-2621. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Adolescent Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Goldstein, Mark Allan can be contacted via phone (617) 726-2730.Contact Information
Primary practice address
55 Fruit St Yaw 6C Pediatric Group Practice
Boston MA 02114-2621
Phone: (617) 726-2730
Fax: (617) 724-3948
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 37840 | Massachusetts |
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 37840 | Massachusetts |
Profile Details
| NPI number | 1588654602 |
|---|---|
| LBN Legal business name | Goldstein, Mark Allan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 28th, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588654602 | NPPES |
| Massachusetts | Other | C04787 | BCBS MA |
| Massachusetts | Other | 037840 | BCBS MA |
| Massachusetts | MEDICAID | 2062267 | BCBS MA |
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