Provider Demographics
NPI:1265554323
Name:GOLD, ALLAN STUART (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:STUART
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:STUART
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6 E EAGER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2506
Mailing Address - Country:US
Mailing Address - Phone:410-727-3240
Mailing Address - Fax:410-727-3240
Practice Address - Street 1:6 E EAGER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2506
Practice Address - Country:US
Practice Address - Phone:410-727-3240
Practice Address - Fax:410-727-3240
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00199942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD557810800Medicaid
MDMD000QMedicare ID - Type Unspecified
MD000QMedicare UPIN