Provider Demographics
NPI:1376898650
Name:GOLD, AMY LAUREN (MS, CPNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:GOLD
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:GOLD
Other - Last Name:BASSFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10301 GEORGIA AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902
Mailing Address - Country:US
Mailing Address - Phone:301-681-6000
Mailing Address - Fax:301-681-3153
Practice Address - Street 1:10301 GEORGIA AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-681-6000
Practice Address - Fax:301-681-3153
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001045363LP0200X
MDR178740363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics