MEDICARE: DR. RANDOLPH GOULD 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
1	174400000X	Specialist	0101035211	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497750780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH GOULD MD

Provider Business Mailing Address
First Line	:	880 KEMPSVILLE RD
Second Line	:	STE. 1000
City	:	NORFOLK
State	:	VA
Zip	:	23502-3931
Country	:	US
Telephone Number	:	757-261-5000
Fax Number	:	757-962-5610

Provider Business Practice Location Address
First Line	:	880 KEMPSVILLE RD
Second Line	:	STE. 1000
City	:	NORFOLK
State	:	VA
Zip	:	23502-3931
Country	:	US
Telephone Number	:	757-261-5000
Fax Number	:	757-962-5610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/18/2010

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