Healthcare Provider Details

I. General information

NPI: 1962505578
Provider Name (Legal Business Name): ROBERT C GOODMAN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COLONIAL RD STE 8 COLONIAL OFFICE PARK
SALEM MA
01970-2947
US

IV. Provider business mailing address

10 COLONIAL RD STE 8 COLONIAL OFFICE PARK
SALEM MA
01970-2947
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-4904
  • Fax: 978-744-2589
Mailing address:
  • Phone: 978-744-4904
  • Fax: 978-744-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMA1635
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberMA1635
License Number StateMA

VIII. Authorized Official

Name: ROBERT C GOODMAN
Title or Position: OWNER PRESIDENT
Credential: DPM PC
Phone: 978-744-4904