Healthcare Provider Details

I. General information

NPI: 1275772048
Provider Name (Legal Business Name): RICHARD PAUL GOODRICH JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CELESTE DR
JOHNSTOWN PA
15905-2832
US

IV. Provider business mailing address

2 CELESTE DR
JOHNSTOWN PA
15905-2832
US

V. Phone/Fax

Practice location:
  • Phone: 814-255-6781
  • Fax:
Mailing address:
  • Phone: 814-255-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO00992
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT-3781
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS016545
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102202441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: