Provider Demographics
NPI:1811976046
Name:GOODLETT, ALLISON H (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:H
Last Name:GOODLETT
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:4701 SPOTSYLVANIA PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-834-5430
Practice Address - Fax:540-834-5431
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3867087OtherAETNA HMO
VACO2375OtherMEDICARE GROUP
VA8133244OtherMAMSI
VA0101238185OtherLICENSE
VA010165237Medicaid
VA7130390OtherAETNA NON HMO
VACA9037OtherMCR RAILROAD GROUP
VA000502782OtherAETNA CAP
VA179657OtherANTHEM
VA3867087OtherAETNA HMO
VACA9037OtherMCR RAILROAD GROUP