Basic Information
| Provider Information | |||||||||
| NPI: | 1578681391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDLUST | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | JONATHAN | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 LAWRENCE EXPY | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950515173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018542500 | ||||||||
| FaxNumber: | 4018542519 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | CLAVERICK 2 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191604 | ||||||||
| FaxNumber: | 4012720538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301083569 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | MD12635 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 939025129 | 01 | RI | RI MEDICARE GROUP NPI | OTHER | 007061003 | 01 | RI | RI MEDICARE | OTHER | 12292008 | 01 | MA | TUFTS | OTHER | 2157454 | 05 | MA | MEDICAID | EG72322 | 05 | RI | MEDICAID | 10302008 | 01 | RI | NHPRI | OTHER | P00711112 | 01 | RI | RAILROAD MEDICARE | OTHER | 09/30/2008 | 01 | RI | BCBS | OTHER | 04/15/2009 | 01 | RI | UNITED HEALTHCARE | OTHER |