MEDICARE: DIAMOND MARIE GOODWIN MD, MHS

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	207VG0400X	Gynecology Physician	2021-01786	NC
2	207VG0400X	Gynecology Physician	A161426	CA

General Provider Information

NPI Number	:	1073044624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMOND MARIE GOODWIN MD, MHS

Provider Business Mailing Address
First Line	:	5221 PARAMOUNT PKWY STE 420
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-5491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 830E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5804
Country	:	US
Telephone Number	:	310-423-6600
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	11/28/2023

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