Provider Demographics
NPI:1588630982
Name:GOLD, STANLEY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ROBERT
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:ROBERT
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27 CARLETON DR
Mailing Address - Street 2:P O BOX 1197
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1231
Mailing Address - Country:US
Mailing Address - Phone:508-888-9059
Mailing Address - Fax:866-302-9338
Practice Address - Street 1:27 CARLETON DR
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1231
Practice Address - Country:US
Practice Address - Phone:508-888-9059
Practice Address - Fax:866-302-9338
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28602207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA438481OtherHPHC
MAJ16338OtherBCBS
A20811Medicare ID - Type Unspecified
MA438481OtherHPHC