Provider Demographics
NPI:1790777654
Name:GOAD, BETTY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:A
Last Name:GOAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1417
Mailing Address - Country:US
Mailing Address - Phone:304-744-0845
Mailing Address - Fax:304-744-8294
Practice Address - Street 1:131 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-744-0845
Practice Address - Fax:304-744-8294
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550770116OtherTAX ID
WV550770116OtherTAX ID
WV2647C252Medicare PIN