Individual
JACK D GOLDSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.1208
Contact information
Practice address
400 MASSASOIT AVE, SUITE 201, E PROVIDENCE, RI 02914-2012
(401) 919-5222
(401) 919-5227
Mailing address
400 MASSASOIT AVE, SUITE 201, E PROVIDENCE, RI 02914-2012
(401) 919-5222
(401) 919-5227
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
RI8073
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000022384
RI BLUE CROSS BLUE SHIELD
RI
01
—
0900689
UNITED HEALTHCARE
PR
01
—
15131
NEIGHBORHOOD HEALTH
RI
01
—
200042974
RAILROAD MEDICARE
RI
01
—
202113
RI BLUE CHIP
RI
01
—
2432493
AETNA US HEALTHCARE
RI
01
—
2797369003
CIGNA
RI
01
—
61829
HARVARD PILGRIM HEALTH CA
RI
01
—
779577
TUFTS
RI
05
—
9020116
—
RI
Enumeration date
05/23/2005
Last updated
11/02/2009
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