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General NPI Number Information
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NPI Number | 1528017803
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Entity Type | Individual
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Provider Name | GREGORY JOHN GOODWORTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 100 CARNIE BLVD SUITE B-5
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City | VOORHEES
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State | NJ
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Zip | 08043-4512
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Country | US
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Telephone | 856-751-0123
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Fax | 856-751-5650
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Provider Business Mailing Address
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Address Line | 1307 WHITE HORSE RD SUITE A-102
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City | VOORHEES
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State | NJ
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Zip | 08043-2176
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Country | US
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Telephone | 856-374-4031
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Fax | 856-232-9139
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA08081700
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License Number State | NJ
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