Healthcare Provider Details

I. General information

NPI: 1942668348
Provider Name (Legal Business Name): BARBARA GOODIN MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST DIVISION OF GENETICS
CHARLOTTESVILLE VA
22908-0386
US

IV. Provider business mailing address

PO BOX 800386 DIVISION OF GENETICS
CHARLOTTESVILLE VA
22908-0386
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2665
  • Fax: 434-924-1797
Mailing address:
  • Phone: 434-924-2665
  • Fax: 434-924-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: