Provider Demographics
NPI:1528140985
Name:GOMOLIN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOMOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-735-9200
Mailing Address - Fax:617-735-9230
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:STE 500
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-735-9200
Practice Address - Fax:617-735-9230
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA49501207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2500375OtherUNITED
MA708332OtherTUFTS
MA3002772Medicaid
MAJ02985OtherBXBS
MA61469OtherHARVARD PILGRIM
RI226220OtherBX OF RI
MA3002772Medicaid
MA61469OtherHARVARD PILGRIM