Healthcare Provider Details

I. General information

NPI: 1386952281
Provider Name (Legal Business Name): VICTORIA GOODMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 BEACON HILL DR
DRESHER PA
19025-1412
US

IV. Provider business mailing address

1844 BEACON HILL DR
DRESHER PA
19025-1412
US

V. Phone/Fax

Practice location:
  • Phone: 215-920-4656
  • Fax:
Mailing address:
  • Phone: 215-920-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA GOODMAN
Title or Position: REGISTERED DIETITIAN
Credential: MS,RD,LDN
Phone: 215-920-4656