1023151099 NPI number — DAVID PAUL GOSSMAN ME.D

Table of content: DAVID PAUL GOSSMAN ME.D (NPI 1023151099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023151099 NPI number — DAVID PAUL GOSSMAN ME.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSSMAN
Provider First Name:
DAVID
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ME.D
Provider Gender Code:
M

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:
1023151099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 JEFFERY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELCHERTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-357-5270
Provider Business Mailing Address Fax Number:
603-357-6875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 JEFFERY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELCHERTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01007-9413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-283-1614
Provider Business Practice Location Address Fax Number:
603-357-6875
Provider Enumeration Date:
02/15/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101Y00000X . This is a "UNLICENSED COUNSELOR" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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