Provider Demographics
NPI:1194749804
Name:GOLD, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:319 S MANNING BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1743
Mailing Address - Country:US
Mailing Address - Phone:518-438-0507
Mailing Address - Fax:518-438-0981
Practice Address - Street 1:19 WEST AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6049
Practice Address - Country:US
Practice Address - Phone:518-583-0111
Practice Address - Fax:518-583-2426
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY122833208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000778OtherCDP
NY4145855OtherMVP
NY000434084003OtherBLUE SHIELD OF NORTHEASTE
NY105151OtherGHI HMO
NY7846749OtherAETNA
RA9605Medicare ID - Type Unspecified
NY7846749OtherAETNA