Provider Demographics
NPI:1326037037
Name:GOLDSTEIN, EDWIN G (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:G
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 1:4043 E SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1144
Mailing Address - Country:US
Mailing Address - Phone:602-840-0882
Mailing Address - Fax:602-840-0778
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:DEPARTMENT OF MEDICAL IMAGING, GOOD SAMARITAN HOSPITAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-239-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ68912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ240375Medicaid
Z119796Medicare PIN
65775Medicare ID - Type UnspecifiedEVDI
AZ240375Medicaid
65773Medicare ID - Type UnspecifiedARL
65774Medicare ID - Type UnspecifiedDOMRI