Provider Demographics
NPI:1891737722
Name:GOODE, DALE NORMAN (MD)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:NORMAN
Last Name:GOODE
Suffix:
Gender:M
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:P.O. BOX 758952
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8952
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:630 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3233
Practice Address - Country:US
Practice Address - Phone:856-812-2220
Practice Address - Fax:856-812-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037601207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3775607Medicaid
NJ3775607Medicaid
NJ3775607Medicaid
D19405Medicare UPIN