MEDICARE: MR. JEFFREY SAMUEL GOLD MD

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	207Q00000X	Family Medicine Physician	224896	MA

General Provider Information

NPI Number	:	1760481642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY SAMUEL GOLD MD

Provider Business Mailing Address
First Line	:	123 PLEASANT STREET
Second Line	:	SUITE 105
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945
Country	:	US
Telephone Number	:	781-842-3961
Fax Number	:	781-990-3467

Provider Business Practice Location Address
First Line	:	123 PLEASANT STREET
Second Line	:	SUITE 105
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945
Country	:	US
Telephone Number	:	781-842-3961
Fax Number	:	781-990-3467

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	10/06/2016

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