1467403725 NPI number — DR. DIANE GOLD PHD

Table of content: DR. DIANE GOLD PHD (NPI 1467403725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467403725 NPI number — DR. DIANE GOLD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLD
Provider First Name:
DIANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLD
Provider Other First Name:
DIANE
Provider Other Middle Name:
MANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467403725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ETON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-428-3620
Provider Business Mailing Address Fax Number:
215-428-0552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YARDLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-428-3620
Provider Business Practice Location Address Fax Number:
215-428-0552
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS002738L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22642400 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001664804 . This is a "BCBS PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".