MEDICARE: DR. CHARLES BRADFORD GOODWIN M.D.

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	207X00000X	Orthopaedic Surgery Physician	130637	NY

General Provider Information

NPI Number	:	1326044314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BRADFORD GOODWIN M.D.

Provider Business Mailing Address
First Line	:	635 MADISON AVE
Second Line	:	FL 7
City	:	NEW YORK
State	:	NY
Zip	:	10022-1009
Country	:	US
Telephone Number	:	212-317-4600
Fax Number	:	212-759-1685

Provider Business Practice Location Address
First Line	:	635 MADISON AVE
Second Line	:	FL 7
City	:	NEW YORK
State	:	NY
Zip	:	10022-1009
Country	:	US
Telephone Number	:	212-857-4600
Fax Number	:	212-752-2454

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	09/13/2012

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