MEDICARE: DR. DAVID ALAN GOODWIN 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	2080N0001X	Neonatal-Perinatal Medicine Physician	0101057468	VA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	MD126101	OR

General Provider Information

NPI Number	:	1679550891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALAN GOODWIN M.D.

Provider Business Mailing Address
First Line	:	5801 BREMO ROAD, NICU 3RD FLOOR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-4330
Country	:	US
Telephone Number	:	804-282-8082
Fax Number	:	804-282-9082

Provider Business Practice Location Address
First Line	:	5801 BREMO ROAD, NICU 3RD FLOOR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-5101
Country	:	US
Telephone Number	:	804-287-7113
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	05/30/2023

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