Healthcare Provider Details

I. General information

NPI: 1821854944
Provider Name (Legal Business Name): ALYSSA GOODWIN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BOWDOIN MILL IS
TOPSHAM ME
04086-1263
US

IV. Provider business mailing address

9 BOWDOIN MILL IS
TOPSHAM ME
04086-1263
US

V. Phone/Fax

Practice location:
  • Phone: 207-406-4462
  • Fax: 207-518-8961
Mailing address:
  • Phone: 207-406-4462
  • Fax: 207-518-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER HOLMES
Title or Position: CLINICAL MANAGER
Credential: CCMA (NHA)
Phone: 207-406-4462