MEDICARE: DR. PETER T GO 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	208600000X	Surgery Physician	MD039319L	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1861472680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER T GO MD

Provider Business Mailing Address
First Line	:	867 WEST MAIN ST
Second Line	:
City	:	SOMERSET
State	:	PA
Zip	:	15501-1235
Country	:	US
Telephone Number	:	814-445-3469
Fax Number	:	814-445-4500

Provider Business Practice Location Address
First Line	:	867 WEST MAIN ST
Second Line	:
City	:	SOMERSET
State	:	PA
Zip	:	15501-1235
Country	:	US
Telephone Number	:	814-445-3469
Fax Number	:	814-445-4500

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/01/2010

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