Provider Demographics
NPI:1215151162
Name:GOLD, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3386
Mailing Address - Country:US
Mailing Address - Phone:609-689-1600
Mailing Address - Fax:
Practice Address - Street 1:2501 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-3386
Practice Address - Country:US
Practice Address - Phone:609-585-8800
Practice Address - Fax:609-585-1825
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00096892085R0202X
NJ25MA089200002085R0202X
FLME1677212085R0202X
PAMD4396562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1215151162Medicaid
PA102490861Medicaid
NJ0270954Medicaid
NJ223742Medicare PIN
PA102490861Medicaid
PA182122Medicare PIN