Provider Demographics
NPI:1649545757
Name:GOODING, GERIROSE (MD)
Entity type:Individual
Prefix:
First Name:GERIROSE
Middle Name:
Last Name:GOODING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 HOSPITAL LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-2600
Mailing Address - Country:US
Mailing Address - Phone:317-745-3740
Mailing Address - Fax:317-745-3816
Practice Address - Street 1:112 HOSPITAL LN STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-2600
Practice Address - Country:US
Practice Address - Phone:317-745-3740
Practice Address - Fax:317-745-3816
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01078271A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery