Healthcare Provider Details

I. General information

NPI: 1093926206
Provider Name (Legal Business Name): GOODTIME FAMILY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 LIBERTY RD STE 103
GWYNN OAK MD
21207-4580
US

IV. Provider business mailing address

5805 MORAVIA RD
BALTIMORE MD
21206-6133
US

V. Phone/Fax

Practice location:
  • Phone: 410-325-5700
  • Fax: 410-325-5765
Mailing address:
  • Phone: 410-325-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RONDA L HERRY
Title or Position: PRACTICE MANAGER
Credential: CPPM
Phone: 410-325-5700