Provider Demographics
NPI:1902028897
Name:GOODING, SUSANE L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANE
Middle Name:L
Last Name:GOODING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-9117
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9117
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:2480 PENNINGTON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5227
Practice Address - Country:US
Practice Address - Phone:609-737-6700
Practice Address - Fax:609-737-2427
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07633100207R00000X
NJ25MA076331002083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0015091Medicaid
NJ074680Medicare PIN