Provider Demographics
NPI:1679577217
Name:GOOD, DONNA M (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:GOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:2419 VALLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6381
Practice Address - Country:US
Practice Address - Phone:540-863-8736
Practice Address - Fax:540-863-8750
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102050229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005635055Medicaid
G76873Medicare UPIN
VA080006701Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH/VAMC
VA005635055Medicaid