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NPI Code Detail

MEDICARE: JOHN M GOLD MD

MEDICARE:   JOHN M GOLD  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician122833NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110000778OTHERNYCDP
24145855OTHERNYMVP
3000434084003OTHERNYBLUE SHIELD OF NORTHEASTE
4105151OTHERNYGHI HMO
57846749OTHERNYAETNA

General Provider Information

NPI Number : 1194749804
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN M GOLD MD
Provider Business Mailing Address
First Line : 319 S MANNING BLVD STE 106
Second Line :
City : ALBANY
State : NY
Zip : 12208-1743
Country : US
Telephone Number : 518-438-0507
Fax Number : 518-438-0981
Provider Business Practice Location Address
First Line : 19 WEST AVE
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-6049
Country : US
Telephone Number : 518-583-0111
Fax Number : 518-583-2426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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Directions to “ JOHN M GOLD MD” Practice Location

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