1760456230 NPI number — DOUGLAS E DEGOOD PHD

Table of content: DOUGLAS E DEGOOD PHD (NPI 1760456230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760456230 NPI number — DOUGLAS E DEGOOD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGOOD
Provider First Name:
DOUGLAS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760456230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-2332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-932-5747
Provider Business Mailing Address Fax Number:
540-932-5748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
FISHERSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22939-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-932-5747
Provider Business Practice Location Address Fax Number:
540-932-5748
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  0810001041 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7711018 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1068499 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 25032 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1046261 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 170228 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 085256 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 284615 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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