Provider Demographics
NPI:1174903769
Name:GOLD, BENJAMIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 SUMMER ST APT 6
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5158
Mailing Address - Country:US
Mailing Address - Phone:516-987-4327
Mailing Address - Fax:
Practice Address - Street 1:112 QUARRY RD STE 400
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4877
Practice Address - Country:US
Practice Address - Phone:516-987-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67576207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease