Provider Demographics
NPI:1912311259
Name:GOOD, KATELYN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:R
Last Name:GOOD
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 1:5 BUCKNAM RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1209
Mailing Address - Country:US
Mailing Address - Phone:207-781-1600
Mailing Address - Fax:207-781-1507
Practice Address - Street 1:5 BUCKNAM RD STE 2B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04105-1209
Practice Address - Country:US
Practice Address - Phone:207-781-1600
Practice Address - Fax:207-781-1507
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMD27270207R00000X
MEMD27270207RH0002X, 208000000X, 207R00000X
IL036.146126207RH0002X
AK147791207RH0002X
IL125064614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1697207Medicaid