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General NPI Number Information
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NPI Number | 1669501805
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Entity Type | Organization
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Legal Business Name | SUBURBAN PSYCHIATRIC ASSOCIATES, L.L.C.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10751 FALLS RD FALLS CONCOURSE, SUITE 306
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4517
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Country | US
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Telephone | 410-583-2723
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Fax | 410-583-2724
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Provider Business Mailing Address
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Address Line | 10751 FALLS RD FALLS CONCOURSE, SUITE 306
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4517
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Country | US
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Telephone | 410-583-2723
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Fax | 410-583-2724
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAVID W GOODMAN
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Credential | M.D.
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Telephone | 410-583-2723
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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 | 2084P080X
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License Number State | MD
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