Healthcare Provider Details

I. General information

NPI: 1831178094
Provider Name (Legal Business Name): ALBERT MARK GOLD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: DR. BERT GOLD

II. Dates (important events)

Enumeration Date: 01/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 KINGFISHER CT
FREDERICK MD
21703-9522
US

IV. Provider business mailing address

6811 KINGFISHER CT
FREDERICK MD
21703-9522
US

V. Phone/Fax

Practice location:
  • Phone: 301-360-0699
  • Fax:
Mailing address:
  • Phone: 301-360-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number96059
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: