Provider Demographics
NPI:1568484004
Name:GOULD, WILLIAM JUDE (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JUDE
Last Name:GOULD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3445 HIGH POINT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3602
Mailing Address - Country:US
Mailing Address - Phone:610-691-2282
Mailing Address - Fax:610-691-2410
Practice Address - Street 1:3445 HIGH POINT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7809
Practice Address - Country:US
Practice Address - Phone:610-691-2282
Practice Address - Fax:610-691-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010000-L207R00000X
PAOS-0100000-L207RG0300X
PAOS010000L208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01196501OtherCAPITAL BLUE CROSS
PA138053OtherAETNA
PA007591588 0002Medicaid
PA849480OtherHIGHMARK
PA873503OtherINDEPENDENCE BLUE CROSS
PAH13246Medicare UPIN
PA146679Medicare PIN
PAH13246Medicare UPIN