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General NPI Number Information
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NPI Number | 1962202291
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Entity Type | Organization
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Legal Business Name | JEFFREY GOODSELL MD PLLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 148 OAK ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-2318
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Country | US
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Telephone | 860-351-7401
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Fax | 833-973-6047
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Provider Business Mailing Address
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Address Line | 148 OAK ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-2318
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Country | US
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Telephone |
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Fax | 860-703-7932
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY GOODSELL
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Credential | MD
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Telephone | 703-268-8843
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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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