Provider Demographics
NPI:1588627459
Name:GOAD, JOHN LEE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:GOAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 CHESTERFIELD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1064
Mailing Address - Country:US
Mailing Address - Phone:681-205-8610
Mailing Address - Fax:681-205-8615
Practice Address - Street 1:2930 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-343-9923
Practice Address - Fax:304-343-9925
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15533207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086097000Medicaid
WVP01087430OtherRAILROAD MEDICARE
WVGO0096497Medicare PIN
WVP01087430OtherRAILROAD MEDICARE
WVE90296Medicare UPIN