Healthcare Provider Details

I. General information

NPI: 1740503689
Provider Name (Legal Business Name): KELLY GOODMAN NP & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SANGAMORE ROAD SUITE S207
BETHESDA MD
20816-2529
US

IV. Provider business mailing address

4701 SANGAMORE ROAD SUITE S207
BETHESDA MD
20816-2529
US

V. Phone/Fax

Practice location:
  • Phone: 202-684-7167
  • Fax: 240-483-0441
Mailing address:
  • Phone: 202-684-7167
  • Fax: 240-483-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR156558
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY ANN GOODMAN
Title or Position: OWNER
Credential: NP
Phone: 202-684-7167