MEDICARE: ANDREW C GOLD P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA06614	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76-0586988	OTHER	TX	TAX ID
2	PA06614	OTHER	TX	PA LICENSE

General Provider Information

NPI Number	:	1285956854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW C GOLD P.A.

Provider Business Mailing Address
First Line	:	PO BOX 5999
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77325-5999
Country	:	US
Telephone Number	:	281-592-8622
Fax Number	:	281-592-8699

Provider Business Practice Location Address
First Line	:	211 S COLLEGE AVE
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4503
Country	:	US
Telephone Number	:	281-592-8622
Fax Number	:	281-592-8699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	03/07/2023

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