Provider Demographics
NPI:1467456939
Name:MARJORIE R GOLD, DO PC
Entity Type:Organization
Organization Name:MARJORIE R GOLD, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO; PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-263-2818
Mailing Address - Street 1:765 5TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4228
Mailing Address - Country:US
Mailing Address - Phone:717-263-2818
Mailing Address - Fax:717-263-6787
Practice Address - Street 1:765 5TH AVE
Practice Address - Street 2:STE C
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4228
Practice Address - Country:US
Practice Address - Phone:717-263-2818
Practice Address - Fax:717-263-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-12
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008915-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1531223Medicaid
GO5498Medicare UPIN
786124Medicare ID - Type Unspecified