Provider Demographics
NPI:1023081965
Name:GOODE, VERA (MD)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:GOODE
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 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-363-1000
Practice Address - Fax:757-460-3708
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherTRICARE
VA541595397OtherCIGNA
VA7427594OtherAETNA
VA153414OtherANTHEM
VA541595397OtherMID ATLANTIC SOLUTIONA
VA010077010Medicaid
VA153414OtherANTHEM
VA541595397OtherCIGNA