Provider Demographics
NPI:1538112784
Name:GOOD, CYNTHIA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JANE
Last Name:GOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3926 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5110
Mailing Address - Country:US
Mailing Address - Phone:302-998-2417
Mailing Address - Fax:302-998-2485
Practice Address - Street 1:16490 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4300
Practice Address - Country:US
Practice Address - Phone:302-998-2417
Practice Address - Fax:302-998-2485
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042587-L207Q00000X
DEC1-0010143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001249580Medicaid
PA678895Medicare ID - Type Unspecified
PA001249580Medicaid