Provider Demographics
NPI:1588616957
Name:GOUGH, WILLIAM C (NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:GOUGH
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:7402 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7532
Mailing Address - Country:US
Mailing Address - Phone:410-821-7471
Mailing Address - Fax:410-821-9582
Practice Address - Street 1:7601 OSLER DRIVE
Practice Address - Street 2:SAINT JOSEPH MEDICAL CENTER
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-337-1226
Practice Address - Fax:410-337-1118
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR079820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ58124Medicare UPIN
MDH822M993Medicare ID - Type Unspecified