Healthcare Provider Details

I. General information

NPI: 1952477135
Provider Name (Legal Business Name): STUART M GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 THE ALAMEDA 106
BERKELEY CA
94707-2311
US

IV. Provider business mailing address

921 THE ALAMEDA 106
BERKELEY CA
94707-2311
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-5800
  • Fax: 510-525-1473
Mailing address:
  • Phone: 510-841-5800
  • Fax: 510-525-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC25113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: