MEDICARE: DR. RICHARD A GO 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
1	207RI0200X	Infectious Disease Physician	231679	NY
2	207RI0200X	Infectious Disease Physician	25MA08108000	NJ

General Provider Information

NPI Number	:	1649283102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A GO M.D.

Provider Business Mailing Address
First Line	:	2768 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5508
Country	:	US
Telephone Number	:	201-451-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2768 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5508
Country	:	US
Telephone Number	:	201-451-0651
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	01/08/2024

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