Healthcare Provider Details

I. General information

NPI: 1942200043
Provider Name (Legal Business Name): GERRI L GOODMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD DERBY ST STE 451
HINGHAM MA
02043-4062
US

IV. Provider business mailing address

160 OLD DERBY ST STE 451
HINGHAM MA
02043-4062
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-3804
  • Fax: 817-749-5853
Mailing address:
  • Phone: 781-534-3804
  • Fax: 781-749-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number222192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: