Provider Demographics
NPI:1043247315
Name:GOLDSTEIN, MARILYN J (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:GOLDSTEIN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-968-4540
Mailing Address - Fax:423-968-5697
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-968-4540
Practice Address - Fax:423-968-5697
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
TNMD030056207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBG2418451OtherDEA
TNF37450Medicare UPIN
TNBG2418451OtherDEA