Provider Demographics
NPI:1316971385
Name:GOLD, MARJORIE BESS GRANOT (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:BESS GRANOT
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BESS
Other - Middle Name:GRANOT
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5111 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-922-4200
Mailing Address - Fax:952-922-4301
Practice Address - Street 1:5111 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2201
Practice Address - Country:US
Practice Address - Phone:952-922-4200
Practice Address - Fax:952-922-4301
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC16181Medicare UPIN