Provider Demographics
NPI:1578852927
Name:GOOD, KRISTIN MARIE (RT(CT))
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:GOOD
Suffix:
Gender:F
Credentials:RT(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 EDGEWOOD DR
Mailing Address - Street 2:APT B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3226
Mailing Address - Country:US
Mailing Address - Phone:540-764-2049
Mailing Address - Fax:
Practice Address - Street 1:170 EDGEWOOD DR
Practice Address - Street 2:APT B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3226
Practice Address - Country:US
Practice Address - Phone:540-764-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4591642471C3401X
VA01200059492471C3401X
AZ158362471C3401X
HI32882471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography