Healthcare Provider Details

I. General information

NPI: 1881788107
Provider Name (Legal Business Name): DAVID J GOODENOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WAYMAN LANE
TRENTON ME
04605-5807
US

IV. Provider business mailing address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5899
  • Fax: 207-667-0378
Mailing address:
  • Phone: 207-288-5081
  • Fax: 207-288-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number011070
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: