Provider Demographics
NPI:1194018887
Name:GOODEN, REGINALD GERALD (MAC,LAC)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:GERALD
Last Name:GOODEN
Suffix:
Gender:M
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KEW GARDEN COURT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-8086
Mailing Address - Country:US
Mailing Address - Phone:443-675-8806
Mailing Address - Fax:
Practice Address - Street 1:8388 COURT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4514
Practice Address - Country:US
Practice Address - Phone:443-675-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01879171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist