Provider Demographics
NPI:1043208853
Name:GOSS, RICHARD A (MED)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:GOSS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12158 FERGUSON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-8613
Mailing Address - Country:US
Mailing Address - Phone:717-242-0469
Mailing Address - Fax:
Practice Address - Street 1:134 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1331
Practice Address - Country:US
Practice Address - Phone:717-248-1403
Practice Address - Fax:717-248-1407
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-007586-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist