Healthcare Provider Details

I. General information

NPI: 1205022365
Provider Name (Legal Business Name): DR. STEPHEN ROBERT GOODNOUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH STREET BUFFALO GENERAL HOSPITAL
BUFFALO NY
14203
US

IV. Provider business mailing address

100 HIGH ST BUFFALO GENERAL HOSPITAL
BUFFALO NY
14203
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone: 716-859-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number156932-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: