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General NPI Number Information
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NPI Number | 1093926206
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Entity Type | Organization
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Legal Business Name | GOODTIME FAMILY CARE, P.C.
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Dates
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Enumeration Date | 05/28/2007
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | 7131 LIBERTY RD STE 103
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City | GWYNN OAK
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State | MD
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Zip | 21207-4580
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Country | US
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Telephone | 410-325-5700
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Fax | 410-325-5765
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Provider Business Mailing Address
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Address Line | 5805 MORAVIA RD
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City | BALTIMORE
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State | MD
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Zip | 21206-6133
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Country | US
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Telephone | 410-325-5700
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | RONDA L HERRY
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Credential | CPPM
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Telephone | 410-325-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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