Individual provider Active NPI

Mark Allan Goldstein, MD

  • Pediatrics Physician
  • Boston, MA
National Provider Identifier
1588654602
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
37840 Issued in MA
Practice address
55 Fruit St
Yaw 6C Pediatric Group Practice
Boston, MA 02114-2621
Phone
(617) 726-2730
Fax
(617) 724-3948
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 37840 MA Primary
Pediatric Adolescent Medicine Physician 2080A0000X 37840 MA

Addresses

Primary practice location

55 Fruit St
Yaw 6C Pediatric Group Practice
Boston, MA 02114-2621

Mailing address

PO Box 9142
Mass General Physician Organization
Charlestown, MA 02129-9142
Phone (617) 724-0287

Other identifiers 3

IdentifierTypeStateIssuer
C04787OtherMABCBS MA
037840OtherMATUFTS HEALTH PLAN
2062267MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050223000137 MA Practitioner - Pediatric Medicine 7315990066 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Pediatrics CurrentSince Mar 15, 2012 Accepting new patients

Locations

55 Fruit St
#6C
Boston, MA 02114
Phone (617) 726-2730

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1588654602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "address_2": "MASS GENERAL PHYSICIAN ORGANIZATION",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-724-0287",
            "fax_number": "617-726-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "YAW 6C PEDIATRIC GROUP PRACTICE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2730",
            "fax_number": "617-724-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSTEIN",
        "first_name": "MARK",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "37840",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MA",
            "license": "37840",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "C04787",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "037840",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2062267",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.