MEDICARE: DR. STUART M 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	2084P0800X	Psychiatry Physician	C25113	CA

General Provider Information

NPI Number	:	1952477135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART M GOLD MD

Provider Business Mailing Address
First Line	:	921 THE ALAMEDA
Second Line	:	106
City	:	BERKELEY
State	:	CA
Zip	:	94707-2311
Country	:	US
Telephone Number	:	510-841-5800
Fax Number	:	510-525-1473

Provider Business Practice Location Address
First Line	:	921 THE ALAMEDA
Second Line	:	106
City	:	BERKELEY
State	:	CA
Zip	:	94707-2311
Country	:	US
Telephone Number	:	510-841-5800
Fax Number	:	510-525-1473

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/09/2007

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