Provider Demographics
NPI:1235116682
Name:GOODCHILD, NIGEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NIGEL
Middle Name:THOMAS
Last Name:GOODCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13624
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3624
Mailing Address - Country:US
Mailing Address - Phone:336-274-4285
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:320 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1900
Practice Address - Country:US
Practice Address - Phone:276-666-7827
Practice Address - Fax:276-666-7566
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010325772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD62191Medicare UPIN
VA00W885S01Medicare PIN