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NPI Code Detail

MEDICARE: DR. LARRY R GOSS DPM

MEDICARE: DR. LARRY R GOSS DPM
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
1213ES0103XFoot & Ankle Surgery PodiatristSC-004111-LPA

Other Identifiers

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

General Provider Information

NPI Number : 1992737506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY R GOSS DPM
Provider Business Mailing Address
First Line : 2075 E ALLEGHENY AVE
Second Line : PO BOX 26848
City : PHILADELPHIA
State : PA
Zip : 19134-3832
Country : US
Telephone Number : 215-425-3700
Fax Number :
Provider Business Practice Location Address
First Line : 2075 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3832
Country : US
Telephone Number : 215-425-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 07/08/2007

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