Provider Demographics
NPI:1255329868
Name:GOULD, AARON GLENN (DPM)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:GLENN
Last Name:GOULD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4435
Mailing Address - Country:US
Mailing Address - Phone:757-561-8671
Mailing Address - Fax:757-986-5445
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:SUITE 1-D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4435
Practice Address - Country:US
Practice Address - Phone:757-561-8671
Practice Address - Fax:757-986-5445
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300820213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0054716OtherCIGNA
VA184314OtherANTHEM BLUE CROSS
VA1850407OtherTHE FIRST HEALTH NETWORK
VA7870748OtherAETNA
VA1098304OtherAETNA HMO
VA202259181OtherHEALTHNET FEDERAL SERVICES
VA690803OtherUNITED HEALTH CARE
VA690803OtherUNITED HEALTH CARE
VA1850407OtherTHE FIRST HEALTH NETWORK