Provider Demographics
NPI:1003834102
Name:GOSSE, RICHARD THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:GOSSE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:RADIATION ONCOLOGY-SOMC
Mailing Address - Street 2:1140 ROUTE 72 WEST
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1026
Mailing Address - Country:US
Mailing Address - Phone:609-978-2194
Mailing Address - Fax:609-978-2843
Practice Address - Street 1:RADIATION ONCOLOGY-SOMC
Practice Address - Street 2:1140 ROUTE 72 WEST
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-0805
Practice Address - Country:US
Practice Address - Phone:609-978-2194
Practice Address - Fax:609-978-2843
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009647363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4144417OtherMVP
NY000405485002OtherBLUE SHIELD
NYQ25149Medicare UPIN
NYPA0996Medicare ID - Type Unspecified