Provider Demographics
NPI:1285642595
Name:GOLDSTEIN, LEON A (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:A
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 1:141 DURHAM RD STE 23
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2658
Mailing Address - Country:US
Mailing Address - Phone:203-245-0350
Mailing Address - Fax:
Practice Address - Street 1:141 DURHAM RD STE 23
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2658
Practice Address - Country:US
Practice Address - Phone:203-245-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06203208200000X
CT26163208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010026163CT01OtherBCBS
2430002996OtherRAILROAD MEDICARE
RI411255OtherBCBS
4357168OtherAETNA
D02910Medicare UPIN
240000053Medicare ID - Type Unspecified