Basic Information
| Provider Information | |||||||||
| NPI: | 1548240039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOS | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 MAIN ST | ||||||||
| Address2: | STE 302 | ||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783717010 | ||||||||
| FaxNumber: | 9783710522 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 BAKER AVENUE EXT STE 302 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017422137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783717010 | ||||||||
| FaxNumber: | 9783710522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 56678 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 5763 | 01 | MA | HEALTHSOURCE | OTHER | 8150 | 01 | MA | FALLON COMMUNITY HEALTH C | OTHER | 070015454 | 01 | MA | RAILROAD MEDICARE | OTHER | J07521 | 01 | MA | BC/BS OF MA | OTHER | 056678 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 4126119 | 01 | MA | AETNA US HEALTH CARE | OTHER | 0009289 | 01 | MA | CIGNA | OTHER | 4293 | 01 | MA | HARVARD COMMUNITY HEALTH | OTHER |