Provider Demographics
NPI:1326019514
Name:GOLDSMITH, GARY O (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:O
Last Name:GOLDSMITH
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 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:MOUNT AUBURN HOSPITAL - CLARK 321
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-497-6096
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:MOUNT AUBURN HOSPITAL - CLARK 321
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-497-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54643207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6198848Medicaid
MAJ04841Medicare ID - Type Unspecified
MA6198848Medicaid