Healthcare Provider Details

I. General information

NPI: 1811976046
Provider Name (Legal Business Name): ALLISON H GOODLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SPOTSYLVANIA PARKWAY SUITE 200
FREDERICKSBURG VA
22408
US

IV. Provider business mailing address

PO BOX 1460
FREDERICKSBURG VA
22402-1460
US

V. Phone/Fax

Practice location:
  • Phone: 540-834-5430
  • Fax: 540-834-5431
Mailing address:
  • Phone: 540-786-2100
  • Fax: 540-786-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101238185
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: