Provider Demographics
NPI:1003531385
Name:GOLD, AMBER (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42759 SUMMERHOUSE PL
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5511
Mailing Address - Country:US
Mailing Address - Phone:540-760-9425
Mailing Address - Fax:
Practice Address - Street 1:42759 SUMMERHOUSE PL
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-5511
Practice Address - Country:US
Practice Address - Phone:540-760-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001066171100000X
MDU02915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist