Healthcare Provider Details

I. General information

NPI: 1386861623
Provider Name (Legal Business Name): CATHERINE ANN DEGOOD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMONS CORNER WAY
SOUTH KINGSTOWN RI
02879-2291
US

IV. Provider business mailing address

20 COMMONS CORNER WAY
SOUTH KINGSTOWN RI
02879-2291
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-6170
  • Fax: 401-295-5255
Mailing address:
  • Phone: 401-294-6170
  • Fax: 401-295-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239753
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO00652
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDO00652
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: