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General NPI Number Information
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NPI Number | 1467581561
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Entity Type | Individual
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Provider Name | CHARLES PHILIP GOODIE PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 ROCKVILLE PIKE STE 145
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City | ROCKVILLE
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State | MD
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Zip | 20852-1631
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Country | US
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Telephone | 240-221-0333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4884
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City | WASHINGTON
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State | DC
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Zip | 20008-0084
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Country | US
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Telephone | 202-291-4581
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004003-1
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License Number State | NY
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