Basic Information
| Provider Information | |||||||||
| NPI: | 1487602868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOODHEALTH P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 368 DORSET ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028601441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 368 DORSET ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028601441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | PITCHER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8028601441 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 47D1068228 | VT | N | Laboratories | Clinical Medical Laboratory | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0VN2426 | 05 | VT | MEDICAID | CB4933 | 01 | VT | RAIL ROAD MEDICARE | OTHER |