Provider Demographics
NPI:1245816214
Name:KELLY-GOSS, MARGARET ROSE (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:KELLY-GOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLLY
Other - Middle Name:ROSE
Other - Last Name:KELLY-GOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 STANIFORD ST FL 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2506
Mailing Address - Country:US
Mailing Address - Phone:617-724-6610
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:800-711-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program