Provider Demographics
NPI:1720344757
Name:GOODALE, AMANDA CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:GOODALE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1775 W LEXINGTON
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3589
Mailing Address - Country:US
Mailing Address - Phone:513-977-6700
Mailing Address - Fax:513-531-2624
Practice Address - Street 1:1775 W LEXINGTON
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3589
Practice Address - Country:US
Practice Address - Phone:513-977-6700
Practice Address - Fax:513-531-2624
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05261986OtherDOB