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General NPI Number Information
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NPI Number | 1053397836
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Entity Type | Organization
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Legal Business Name | THEODORE GOODMAN MD
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 WASHINGTON ST
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City | CANTON
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State | MA
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Zip | 02021-2562
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Country | US
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Telephone | 781-828-3019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9132
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City | BROOKLINE
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State | MA
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Zip | 02446-9132
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Country | US
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Telephone | 800-927-0002
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE GOODMAN
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Credential | MD
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Telephone | 800-927-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MA
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