Healthcare Provider Details

I. General information

NPI: 1710937123
Provider Name (Legal Business Name): JOHN J GOODILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD MAP 1, SUITE 220
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD MAP 1, SUITE 220
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-5515
  • Fax: 302-366-1240
Mailing address:
  • Phone: 302-368-5515
  • Fax: 302-366-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC10002306
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: