Provider Demographics
NPI:1548224967
Name:GOUGE, THOMAS HAMILTON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HAMILTON
Last Name:GOUGE
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 1:336 CENTRAL PARK W
Mailing Address - Street 2:12 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7107
Mailing Address - Country:US
Mailing Address - Phone:212-951-3366
Mailing Address - Fax:212-951-3373
Practice Address - Street 1:336 CENTRAL PARK W
Practice Address - Street 2:12 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7107
Practice Address - Country:US
Practice Address - Phone:212-951-3366
Practice Address - Fax:212-951-3373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY118389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery