1922374792 NPI number — DR. ANTOINETTE GOLDEN M.D.

Table of content: DR. ANTOINETTE GOLDEN M.D. (NPI 1922374792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922374792 NPI number — DR. ANTOINETTE GOLDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDEN
Provider First Name:
ANTOINETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922374792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 WHIPPLE ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02908-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-854-2504
Provider Business Mailing Address Fax Number:
401-427-7795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
164 SUMMIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-793-3100
Provider Business Practice Location Address Fax Number:
401-793-3105
Provider Enumeration Date:
03/27/2012

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: 207P00000X , with the licence number:  ME.127153 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: MD14996 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1922374792 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: U400217887 . This is a "MEDICARE NGS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 110102843A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018267000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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