Healthcare Provider Details

I. General information

NPI: 1508870205
Provider Name (Legal Business Name): CHARLES D. GOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR SUITE 213
FISHERSVILLE VA
22939
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7705
  • Fax: 540-245-7710
Mailing address:
  • Phone: 540-245-7705
  • Fax: 540-245-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101056658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: