Basic Information
| Provider Information | |||||||||
| NPI: | 1689673337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODSPEED | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 151 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197200151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026522455 | ||||||||
| FaxNumber: | 3023226251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198053420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026555822 | ||||||||
| FaxNumber: | 3026553541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C2-00007022 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000028579 | 05 | DE | MEDICAID |