Healthcare Provider Details

I. General information

NPI: 1891911277
Provider Name (Legal Business Name): BEN RICHARD GOODGAME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN-STANTON ROAD AMMON BUILDING, SUITE 2E70
NEWARK DE
19718-2249
US

IV. Provider business mailing address

200 HYGEIA DRIVE CCHS PHYSICIAN CONTRACTING, SUITE 2300
NEWARK DE
19713-2249
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-5515
  • Fax: 302-733-6082
Mailing address:
  • Phone: 302-437-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberEI0305
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2015-01376
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC1-0008404
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: