Healthcare Provider Details

I. General information

NPI: 1457415366
Provider Name (Legal Business Name): JESSE LYLE GOODMAN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

MEDSTAR GEORGETOWN UNIVERSITY 3800 RESERVOIR ROAD
WASHINGTON DC
20057-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 202-687-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number30,004
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD034378
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: