Provider Demographics
NPI:1770291502
Name:GOOD, REGINALD CHRISTOPHER
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:CHRISTOPHER
Last Name:GOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4852
Mailing Address - Country:US
Mailing Address - Phone:215-833-6010
Mailing Address - Fax:
Practice Address - Street 1:529 N 58TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4852
Practice Address - Country:US
Practice Address - Phone:215-833-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other