Provider Demographics
NPI:1255377180
Name:GOODING, FREDERICK WAYNE SR (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WAYNE
Last Name:GOODING
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:W
Other - Last Name:GOODING MD&ASSOCIATES P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-0200
Mailing Address - Country:US
Mailing Address - Phone:302-530-1618
Mailing Address - Fax:302-652-1023
Practice Address - Street 1:1600 PENNSYLVANIA AVE
Practice Address - Street 2:STE D
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4047
Practice Address - Country:US
Practice Address - Phone:302-530-1618
Practice Address - Fax:302-652-1023
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026232900Medicaid
DE1000023477Medicaid
DE1000023477Medicaid
DCA84486Medicare UPIN
DE00B938G69Medicare ID - Type Unspecified