Healthcare Provider Details

I. General information

NPI: 1922374792
Provider Name (Legal Business Name): ANTOINETTE GOLDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

125 WHIPPLE ST 3RD FLOOR
PROVIDENCE RI
02908-3258
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-3100
  • Fax: 401-793-3105
Mailing address:
  • Phone: 401-854-2504
  • Fax: 401-427-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME.127153
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD14996
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: