Individual
PROF. ERIC JONATHAN GOLDLUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
700 LAWRENCE EXPY, SANTA CLARA, CA 95051-5173
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12635
RI
390200000X
Student in an Organized Health Care Education/Training Program
4301083569
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007061003
RI MEDICARE
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
09/30/2008
BCBS
RI
01
—
10302008
NHPRI
RI
01
—
12292008
TUFTS
MA
05
—
2157454
—
MA
01
—
939025129
RI MEDICARE GROUP NPI
RI
05
—
EG72322
—
RI
01
—
P00711112
RAILROAD MEDICARE
RI
Enumeration date
03/27/2007
Last updated
01/14/2022
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