MEDICARE: MICHAEL GOODKIN 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
1	207RC0000X	Cardiovascular Disease Physician	MD019064E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043284656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GOODKIN MD

Provider Business Mailing Address
First Line	:	207 N BROAD ST
Second Line	:	3RD FLR.
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-1500
Country	:	US
Telephone Number	:	215-462-7100
Fax Number	:	215-463-3820

Provider Business Practice Location Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	SUITE 2400
City	:	MEDIA
State	:	PA
Zip	:	19063-5146
Country	:	US
Telephone Number	:	610-565-2100
Fax Number	:	610-892-0626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/15/2011

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Directions to “ MICHAEL GOODKIN MD” Practice Location

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