Provider Demographics
NPI:1275526147
Name:GOLD, MICHAEL N (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6154
Mailing Address - Country:US
Mailing Address - Phone:603-465-3208
Mailing Address - Fax:
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:SUITE 1538
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3239
Practice Address - Country:US
Practice Address - Phone:603-889-4431
Practice Address - Fax:603-889-1572
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6923207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6383OtherCIGNA/HEALTHSOURCE
NH00000598Medicaid
NH220013063OtherRAILROAD MEDICARE
NH0107569Y0NH01OtherBC/BS
NH006923OtherTUFTS
NH782996OtherMVP INS
NHNH8831Medicare ID - Type Unspecified
NH0107569Y0NH01OtherBC/BS