Provider Demographics
NPI:1326230830
Name:FREDERICK W. GOODING, M.D. & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FREDERICK W. GOODING, M.D. & ASSOCIATES, P.C.
Other - Org Name:GOODING MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:202-269-1495
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-269-1495
Mailing Address - Fax:202-269-1039
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-269-1495
Practice Address - Fax:202-269-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01269Medicare PIN