Healthcare Provider Details

I. General information

NPI: 1295711364
Provider Name (Legal Business Name): NANCY GOEDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 SALEM CHURCH RD.
FREDERICKSBURG VA
22407
US

IV. Provider business mailing address

2632 SALEM CHURCH ROAD
FREDERICKSBURG VA
22407
US

V. Phone/Fax

Practice location:
  • Phone: 540-899-3440
  • Fax: 540-899-3434
Mailing address:
  • Phone: 540-899-3430
  • Fax: 540-899-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101038304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: