Provider Demographics
NPI:1013920040
Name:GOLD, KENNETH J (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HUHS
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-8414
Mailing Address - Fax:617-496-0560
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HUHS
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-495-8414
Practice Address - Fax:617-496-0560
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-01-14
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Provider Licenses
StateLicense IDTaxonomies
MA59354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA059354OtherTUFTS HEALTH PLAN
MAJ12223OtherBC/BS OF MA
MA059354OtherTUFTS HEALTH PLAN
MA059354OtherTUFTS HEALTH PLAN