Provider Demographics
NPI:1659374072
Name:GOLD, MELVIN H JR (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:H
Last Name:GOLD
Suffix:JR
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 1:4228 HOUMA BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-456-8020
Mailing Address - Fax:504-456-8021
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-456-8020
Practice Address - Fax:504-456-8021
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11748207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1199036Medicaid
LA5L882CR97Medicare PIN
B61529Medicare UPIN
LA5L882Medicare PIN