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General NPI Number Information
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NPI Number | 1174618748
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Entity Type | Organization
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Legal Business Name | THEODORE A. GOODMAN MD INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1341 BURNETT WAY
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City | SACRAMENTO
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State | CA
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Zip | 95818-2221
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Country | US
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Telephone | 916-452-5909
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Fax | 916-943-0790
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Provider Business Mailing Address
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Address Line | 7700 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95826
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Country | US
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Telephone | 916-386-3645
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Fax | 916-386-3050
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE AVRAM GOODMAN
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Credential | MD
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Telephone | 916-452-5909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G35973
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License Number State | CA
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