Provider Demographics
NPI:1699728782
Name:GOLD, LARISSA (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 ROCKAWAY PKWY
Mailing Address - Street 2:APT.#2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3444
Mailing Address - Country:US
Mailing Address - Phone:347-920-6647
Mailing Address - Fax:718-688-7185
Practice Address - Street 1:205 ROCKAWAY PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:347-920-6647
Practice Address - Fax:718-688-7185
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225541207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine