Provider Demographics
NPI:1811510282
Name:GOLDSTEIN, LARA NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:NICOLE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 BISCAYNE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-682-2483
Mailing Address - Fax:305-682-5250
Practice Address - Street 1:20900 BISCAYNE BOULEVARD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-682-2483
Practice Address - Fax:305-682-5250
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2024-12-13
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-10
Provider Licenses
StateLicense IDTaxonomies
FLME160989207P00000X
KY60258207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program