Provider Demographics
NPI:1326078874
Name:GOULD, CHARLES FROST II (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FROST
Last Name:GOULD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7702 E PARHAM RD
Mailing Address - Street 2:MOB III SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4371
Mailing Address - Country:US
Mailing Address - Phone:804-346-1612
Mailing Address - Fax:804-346-1536
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:MOB III SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-346-1612
Practice Address - Fax:804-346-1536
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010460452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7312865Medicaid
A43371Medicare UPIN
VA770000078Medicare ID - Type Unspecified