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NPI Code Detail

MEDICARE: MR. HARRISON GOODALL III MD

MEDICARE: MR. HARRISON GOODALL III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD494025PA

General Provider Information

NPI Number : 1013610237
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HARRISON GOODALL III MD
Provider Business Mailing Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 800-836-7536
Fax Number :
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 800-836-7536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2023
Last Update Date : 06/17/2026

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