Basic Information
| Provider Information | |||||||||
| NPI: | 1083789812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOULD | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172 KINSLEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823000 | ||||||||
| FaxNumber: | 6038893774 | ||||||||
| Practice Location | |||||||||
| Address1: | 172 KINSLEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823000 | ||||||||
| FaxNumber: | 6038893774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 11131 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 11131 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04Y002866NH01 | 01 | NH | ANTHEM | OTHER | 930103225 | 01 | NH | RAILROAD MEDICARE | OTHER | 311211 | 05 | MA | MEDICAID | 30221416 | 05 | NH | MEDICAID | AA98616 | 01 | HARVARD PILGRIM | OTHER | 415920 | 01 | CIGNA | OTHER |