Healthcare Provider Details

I. General information

NPI: 1144335928
Provider Name (Legal Business Name): ROBERT STEVEN GOODWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 ALEXANDER BELL DR # 300
COLUMBIA MD
21046-2248
US

IV. Provider business mailing address

6740 ALEXANDER BELL DR # 300
COLUMBIA MD
21046-2248
US

V. Phone/Fax

Practice location:
  • Phone: 410-564-0000
  • Fax: 410-564-0032
Mailing address:
  • Phone: 410-564-0000
  • Fax: 410-564-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD23081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: