Provider Demographics
NPI:1184606394
Name:GOSS, PAUL EDWARD (MBBCH)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:GOSS
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-6500
Mailing Address - Fax:617-724-1079
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:COX BUILDING STE 640
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2617
Practice Address - Country:US
Practice Address - Phone:617-724-3118
Practice Address - Fax:617-724-3166
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220533207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28127OtherBCBS MA
MA469900OtherTUFTS HEALTH PLAN
MA2084465Medicaid
I18701Medicare UPIN
MAJ28127OtherBCBS MA