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General NPI Number Information
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NPI Number | 1053315036
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Entity Type | Individual
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Provider Name | TODD A GOODGLICK MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1209
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4301
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Country | US
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Telephone | 301-841-6595
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Fax | 301-797-9454
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Provider Business Mailing Address
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Address Line | 5454 WISCONSIN AVE STE 950
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6912
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Country | US
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Telephone | 301-657-5700
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Fax | 301-654-9132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 0101043516
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | MD21176
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | 0101043516
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | D0037803
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | MD21176
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License Number State | DC
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Taxonomy #6
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | D0037803
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License Number State | MD
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Taxonomy #7
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101043516
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD21176
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License Number State | DC
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Taxonomy #9
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0037803
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License Number State | MD
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