Healthcare Provider Details

I. General information

NPI: 1104116409
Provider Name (Legal Business Name): CAROLINE GAGEL GOODCHILD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E EVESHAM RD SUITE A
VOORHEES NJ
08043-9590
US

IV. Provider business mailing address

2401 E EVESHAM RD STE A1 SUITE 300
VOORHEES NJ
08043-9590
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-3323
  • Fax: 856-424-4994
Mailing address:
  • Phone: 856-424-3323
  • Fax: 856-424-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09675900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: