Provider Demographics
NPI:1891859070
Name:WILLIAM C. GO, JR., M.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM C. GO, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:GO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:814-254-4727
Mailing Address - Street 1:1425 SCALP AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3328
Mailing Address - Country:US
Mailing Address - Phone:814-254-4727
Mailing Address - Fax:814-254-4729
Practice Address - Street 1:1425 SCALP AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3328
Practice Address - Country:US
Practice Address - Phone:814-254-4727
Practice Address - Fax:814-254-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033934L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006039900001Medicaid
PA0006039900001Medicaid
PAB40020Medicare UPIN