Provider Demographics
NPI:1801480876
Name:GOODE, KELVIN
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:
Last Name:GOODE
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 1:2135 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1351
Mailing Address - Country:US
Mailing Address - Phone:202-391-4010
Mailing Address - Fax:
Practice Address - Street 1:3335 D ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2302
Practice Address - Country:US
Practice Address - Phone:202-391-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant