Provider Demographics
NPI:1134199433
Name:GOLDSTEIN, LAWRENCE S (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 WINDHAM CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5087
Mailing Address - Country:US
Mailing Address - Phone:330-726-3357
Mailing Address - Fax:330-726-1465
Practice Address - Street 1:960 WINDHAM CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5087
Practice Address - Country:US
Practice Address - Phone:330-726-3357
Practice Address - Fax:330-726-1465
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063779207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0349000Medicaid
OH0349000Medicaid
OHG39043Medicare UPIN