Healthcare Provider Details

I. General information

NPI: 1346565884
Provider Name (Legal Business Name): DAVID S GOODWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25055 RIDING PLZ STE 260
CHANTILLY VA
20152-5917
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-272-5000
  • Fax: 703-957-3804
Mailing address:
  • Phone: 703-444-5000
  • Fax: 703-444-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101260025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: