Provider Demographics
NPI:1619998002
Name:GOULD, HERBERT BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:BENNETT
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 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-963-9222
Mailing Address - Fax:
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE # 204
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-963-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist