MEDICARE: DR. GERRI L 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
1	207W00000X	Ophthalmology Physician	222192	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
2	J28395	OTHER		BCBS

General Provider Information

NPI Number	:	1942200043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERRI L GOODMAN MD

Provider Business Mailing Address
First Line	:	160 OLD DERBY ST STE 451
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4062
Country	:	US
Telephone Number	:	781-534-3804
Fax Number	:	781-749-5853

Provider Business Practice Location Address
First Line	:	160 OLD DERBY ST STE 451
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4062
Country	:	US
Telephone Number	:	781-534-3804
Fax Number	:	817-749-5853

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/28/2023

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