Individual
JERRY GOLDSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-3013
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
35-076513
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221401
UNISON
OH
01
—
000000503634
ANTHEM
—
05
—
2132801
—
OH
01
—
363568
WELLCARE
OH
01
—
4419730
AETNA
—
01
—
745999
BUCKEYE
OH
01
—
P00216359
RAILROAD MEDICARE
OH
01
—
P00385110
RAILROAD MEDICARE
OH
Enumeration date
07/10/2006
Last updated
06/30/2011
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