Provider Demographics
NPI:1386861623
Name:DEGOOD, CATHERINE ANN (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:DEGOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMONS CORNER WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2291
Mailing Address - Country:US
Mailing Address - Phone:401-294-6170
Mailing Address - Fax:401-295-5255
Practice Address - Street 1:20 COMMONS CORNER WAY
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2291
Practice Address - Country:US
Practice Address - Phone:401-294-6170
Practice Address - Fax:401-295-5255
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239753207Q00000X
RIDO00652207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICD78876Medicaid
RI001480401OtherMEDICARE PTAN