MEDICARE: MR. TODD A GOODGLICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	0101043516	VA
2	207WX0109X	Neuro-ophthalmology Physician	MD21176	DC
3	207WX0109X	Neuro-ophthalmology Physician	0101043516	VA
4	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	D0037803	MD
5	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	MD21176	DC
6	207WX0109X	Neuro-ophthalmology Physician	D0037803	MD
7	207W00000X	Ophthalmology Physician	0101043516	VA
8	207W00000X	Ophthalmology Physician	MD21176	DC
9	207W00000X	Ophthalmology Physician	D0037803	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053315036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD A GOODGLICK MD

Provider Business Mailing Address
First Line	:	5454 WISCONSIN AVE STE 950
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6912
Country	:	US
Telephone Number	:	301-657-5700
Fax Number	:	301-654-9132

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE STE 1209
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4301
Country	:	US
Telephone Number	:	301-841-6595
Fax Number	:	301-797-9454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/16/2024

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Directions to “ MR. TODD A GOODGLICK MD” Practice Location

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