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1538112784

NPI Code Detail

MEDICARE: DR. CYNTHIA JANE GOOD MD

MEDICARE: DR. CYNTHIA JANE GOOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD042587-L	PA
2	207Q00000X	Family Medicine Physician	C1-0010143	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538112784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA JANE GOOD MD

Provider Business Mailing Address
First Line	:	3926 KIRKWOOD HWY
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-5110
Country	:	US
Telephone Number	:	302-998-2417
Fax Number	:	302-998-2485

Provider Business Practice Location Address
First Line	:	16490 W 78TH ST
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4300
Country	:	US
Telephone Number	:	302-998-2417
Fax Number	:	302-998-2485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/06/2017

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Directions to “ DR. CYNTHIA JANE GOOD MD” Practice Location

Language	Start Address	Practice Location

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