Healthcare Provider Details

I. General information

NPI: 1740452085
Provider Name (Legal Business Name): CHRISTOPHER GOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 05/24/2021
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST 2ND FLOOR
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST FL 2 2ND FLOOR
ERIE PA
16507-1579
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-8980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS013933
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: