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NPI Code Detail

MEDICARE: DR. NICHOLAS CHARLES GOLDEN M.D.

MEDICARE: DR. NICHOLAS CHARLES GOLDEN M.D.
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
1207RG0100XGastroenterology PhysicianME151295FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619978343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS CHARLES GOLDEN M.D.
Provider Business Mailing Address
First Line : 34940 RIDGE RD
Second Line : SUITE B
City : WILLOUGHBY
State : OH
Zip : 44094-4196
Country : US
Telephone Number : 440-953-1899
Fax Number : 440-953-9281
Provider Business Practice Location Address
First Line : 1000 36TH ST STE B
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-4862
Country : US
Telephone Number : 772-567-4311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/11/2021

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