MEDICARE: PATRICIA GOODMAN CRNP

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	363LP2300X	Primary Care Nurse Practitioner	R149467	MD

General Provider Information

NPI Number	:	1376017236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GOODMAN CRNP

Provider Business Mailing Address
First Line	:	PO BOX 157
Second Line	:
City	:	ASHTON
State	:	MD
Zip	:	20861-0157
Country	:	US
Telephone Number	:	301-570-9700
Fax Number	:	301-260-2838

Provider Business Practice Location Address
First Line	:	7013 COPPER SKY CT
Second Line	:
City	:	UPPR MARLBORO
State	:	MD
Zip	:	20772-4398
Country	:	US
Telephone Number	:	202-460-1398
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	08/16/2019

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