Provider Demographics
NPI:1366497067
Name:GOOD, ANNE MARIE PUCKHABER (MD)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:PUCKHABER
Last Name:GOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE MARIE
Other - Middle Name:ELIZABETH
Other - Last Name:PUCKHABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1871 SAVAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-766-6308
Mailing Address - Fax:843-804-9883
Practice Address - Street 1:1871 SAVAGE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-766-6308
Practice Address - Fax:843-804-9883
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC226703Medicaid