Healthcare Provider Details

I. General information

NPI: 1477542637
Provider Name (Legal Business Name): WILLIAM S GOODMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST
NATICK MA
01760-7700
US

IV. Provider business mailing address

460 TOTTEN POND RD C/O MZI
WALTHAM MA
02451-1991
US

V. Phone/Fax

Practice location:
  • Phone: 508-651-1144
  • Fax: 508-653-9759
Mailing address:
  • Phone: 781-890-9933
  • Fax: 781-890-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35554
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: