Provider Demographics
NPI:1801944921
Name:GOULD, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-0922
Mailing Address - Country:US
Mailing Address - Phone:973-450-1155
Mailing Address - Fax:973-751-5741
Practice Address - Street 1:50 NEWARK AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1185
Practice Address - Country:US
Practice Address - Phone:973-450-1155
Practice Address - Fax:973-751-5741
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5695476OtherAETNA
58762OtherAMERIGROUP
NJ60002159OtherHORIZON NJ HEALTH
3514963OtherCIGNA
P2469090OtherOXFORD