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NPI Code Detail

MEDICARE: MARK GOODMAN MD

MEDICARE: MARK GOODMAN 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
1208000000XPediatrics PhysicianA31080CA

Other Identifiers

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

General Provider Information

NPI Number : 1629005780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK GOODMAN MD
Provider Business Mailing Address
First Line : 2360 PACIFIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-3051
Country : US
Telephone Number : 562-981-6856
Fax Number : 562-426-7792
Provider Business Practice Location Address
First Line : 3200 LONG BEACH BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-5062
Country : US
Telephone Number : 562-933-2000
Fax Number : 562-494-7792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 10/12/2007

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