Provider Demographics
NPI:1619978343
Name:GOLDEN, NICHOLAS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:GOLDEN
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 1:34940 RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4196
Mailing Address - Country:US
Mailing Address - Phone:440-953-1899
Mailing Address - Fax:440-953-9281
Practice Address - Street 1:1000 36TH ST STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151295207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839358Medicaid
NY14F731Medicare UPIN