Healthcare Provider Details

I. General information

NPI: 1275526147
Provider Name (Legal Business Name): MICHAEL N GOLD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BROAD ST SUITE 1538
NASHUA NH
03063-3239
US

IV. Provider business mailing address

2 WRIGHT RD
HOLLIS NH
03049-6154
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-4431
  • Fax: 603-889-1572
Mailing address:
  • Phone: 603-465-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6923
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: