Provider Demographics
NPI:1679631949
Name:GOULD, DEBORAH JEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:GOULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23210 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5429
Mailing Address - Country:US
Mailing Address - Phone:216-831-6466
Mailing Address - Fax:216-766-6083
Practice Address - Street 1:23210 CHAGRIN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5429
Practice Address - Country:US
Practice Address - Phone:216-831-6466
Practice Address - Fax:216-766-6083
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350361482084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000345557OtherBLUE CROSS SHIELD
OH880908Medicaid
000000345557OtherBLUE CROSS SHIELD
F31282Medicare UPIN