MEDICARE: DR. ROBERT L. GOODMAN M.D.

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	2086S0129X	Vascular Surgery Physician	44739	MA

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

General Provider Information

NPI Number	:	1487754156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. GOODMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1163
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01090-1163
Country	:	US
Telephone Number	:	413-781-1576
Fax Number	:	413-785-1812

Provider Business Practice Location Address
First Line	:	66 MORGAN RD
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-1410
Country	:	US
Telephone Number	:	413-781-1576
Fax Number	:	413-785-1812

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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