Basic Information
| Provider Information | |||||||||
| NPI: | 1598177834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | MEREDITH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 J CLYDE MORRIS BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573165800 | ||||||||
| FaxNumber: | 7575345190 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 SHADY LN | ||||||||
| Address2: | |||||||||
| City: | WHITE STONE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225782601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044353133 | ||||||||
| FaxNumber: | 8044351311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2014 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101021011 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 0102205259 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 5101021011 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 0102205259 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.