Healthcare Provider Details

I. General information

NPI: 1821089327
Provider Name (Legal Business Name): THOMAS HAMPTON GOODRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 202
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE STE 202
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-9101
  • Fax: 301-681-3525
Mailing address:
  • Phone: 301-681-9101
  • Fax: 301-681-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0013811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: