Healthcare Provider Details

I. General information

NPI: 1841936994
Provider Name (Legal Business Name): SAMANTHA AMANDA GOULD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 THEATRE DR
JOHNSTOWN PA
15904-3221
US

IV. Provider business mailing address

374 THEATRE DR # 165904
JOHNSTOWN PA
15904-3221
US

V. Phone/Fax

Practice location:
  • Phone: 814-619-4587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: