Provider Demographics
NPI:1457318578
Name:SAMUEL C GOLD MD PA
Entity Type:Organization
Organization Name:SAMUEL C GOLD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-641-5081
Mailing Address - Street 1:835 HANOVER ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-641-5081
Mailing Address - Fax:603-641-5348
Practice Address - Street 1:835 HANOVER ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-641-5081
Practice Address - Fax:603-641-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7982207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002630Medicaid
B58002Medicare UPIN
NHNH9728Medicare ID - Type Unspecified