Provider Demographics
NPI:1619183027
Name:GOULD, IRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:A
Last Name:GOULD
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 1:365A WEST 28TH STREET
Mailing Address - Street 2:GROUND FLOOR, SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7901
Mailing Address - Country:US
Mailing Address - Phone:212-725-7185
Mailing Address - Fax:212-725-7168
Practice Address - Street 1:365 A WEST 28TH STREET
Practice Address - Street 2:GROUND FLOOR, SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7901
Practice Address - Country:US
Practice Address - Phone:212-725-7185
Practice Address - Fax:212-725-7168
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094552207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D0956128OtherCLIA
NY506221OtherBLUE CROSS BLUE SHIELD
NY094552-7OtherWORKERS' COMP. BOARD
NY00155633Medicaid
NY0042589OtherGHI
NYB15655Medicare UPIN
NY506221OtherBLUE CROSS BLUE SHIELD