Provider Demographics
NPI:1164469755
Name:GOULD, NATHANIEL S (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:S
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:SLOCUM DICKSON MEDICAL GROUP PLLC
Mailing Address - Street 2:1729 BURRSTONE ROAD
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-798-1700
Mailing Address - Fax:
Practice Address - Street 1:SLOCUM DICKSON MEDICAL GROUP PLLC
Practice Address - Street 2:1729 BURRSTONE ROAD
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-798-1700
Practice Address - Fax:315-798-1707
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-05-31
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Provider Licenses
StateLicense IDTaxonomies
NY243697208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02866104Medicaid
RA4385Medicare PIN