Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 239753 | NY |
Y | 207Q00000X | Family Doctor | DO00652 | RI |
N | 207QA0401X | Family Doctor - Addiction Medicine | DO00652 | RI |
NPI | 1386861623 |
---|---|
Provider Name | Catherine Ann Degood |
First Address | South Kingstown, RI 02879-2291 |
Second Address | South Kingstown, RI 02879-2291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001480401 | MEDICARE PTAN (01) | RI |
CD78876 | (05) | RI |