Provider Demographics
NPI:1396764197
Name:GOLDSTEIN, LARRY E (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
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 1:833 CHESTNUT STREET
Mailing Address - Street 2:SUITE 703
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-1000
Mailing Address - Fax:215-923-2275
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:SUITE 703
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-1000
Practice Address - Fax:215-923-2275
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000141171100000X
PAMD-015799-E208800000X
PAMD015799E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7901607Medicaid
PA000678427 0008Medicaid
NJ7901607Medicaid
PA031910XDKMedicare PIN
PAC28049Medicare UPIN