Provider Demographics
NPI:1386688828
Name:GOLDSTON, JAMES I (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:I
Last Name:GOLDSTON
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 1:5 UPLAND WOODS CIR UNIT 208
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3192
Mailing Address - Country:US
Mailing Address - Phone:617-962-6151
Mailing Address - Fax:
Practice Address - Street 1:42 WESTON ST STE 2A
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7756
Practice Address - Country:US
Practice Address - Phone:781-747-8480
Practice Address - Fax:949-577-4121
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA733312080P0006X, 2080P0008X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001248733OtherUNITED HEALTH CARE #
MA201253OtherHPHC #
MA28929OtherCHILDRENS MEDICAL SECURIT
MA30690441Medicaid
MA4266105OtherAETNA #
MA073331OtherTUFTS #
40263OtherUNITED HEALTHCARE
MA195221OtherPHCS #
MAJ10471OtherBCBSMA
0029449OtherCIGNA #
MA9787429Medicaid