Provider Demographics
NPI:1144286261
Name:GOLDEN, MARJORIE P (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:P
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 N SASCO CMN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4181
Mailing Address - Country:US
Mailing Address - Phone:203-789-3566
Mailing Address - Fax:203-789-4239
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-3566
Practice Address - Fax:203-789-4239
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033703207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1337030Medicaid
CT1337030Medicaid
CT110010040Medicare PIN