1801810726 NPI number — CHRISTINA M KREMER-GOODSON MD

Table of content: CHRISTINA M KREMER-GOODSON MD (NPI 1801810726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801810726 NPI number — CHRISTINA M KREMER-GOODSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREMER-GOODSON
Provider First Name:
CHRISTINA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREMER
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801810726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 OHIO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-339-5786
Provider Business Mailing Address Fax Number:
740-446-2593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 OHIO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLIPOLIS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45631-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-339-5786
Provider Business Practice Location Address Fax Number:
740-446-2593
Provider Enumeration Date:
07/26/2006

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: 207Q00000X , with the licence number:  35.082143 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2419341 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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