Provider Demographics
NPI:1750597076
Name:GOLDSTEIN, JEROME ERIC (MD,JD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ERIC
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2313
Mailing Address - Country:US
Mailing Address - Phone:267-795-7934
Mailing Address - Fax:
Practice Address - Street 1:2257 SHADY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2313
Practice Address - Country:US
Practice Address - Phone:267-795-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040010L207R00000X, 207RC0000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine