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Individual

DR. WALLACE HANNA GOOD JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12 LAKEMOUNT DR, SAINT ALBANS, VT 05478-0386
(802) 524-5867
Mailing address
PO BOX 386, SAINT ALBANS, VT 05478-0386
(802) 452-5817

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
042-0006834
VT
207L00000X
Anesthesiology Physician
144954
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0006375
VT
05
01053034
NY
01
06375
BLUE SHIELD
VT
01
86095
MVP
VT
Enumeration date
07/10/2006
Last updated
07/08/2007
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