MEDICARE: DR. LOIS S. GOODMAN 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	207VG0400X	Gynecology Physician	36529	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0016763	OTHER	MA	NHP-MA (10)
2	036529	OTHER	MA	TUFTS
3	GOMO9146	OTHER	MA	BCBS (6)
4	36529	OTHER	MA	MEDICAL LICENSE (1)
5	GOMO9146	OTHER	MA	BCBS-MA (218)
6	043550681	OTHER	MA	HEALTH NET OF NE (62)
7	27416	OTHER	MA	CMSP/HSP (401)
8	3580607003	OTHER	MA	CIGNA (33)
9	13636	OTHER	MA	HPHC
10	578760	OTHER	MA	HEALTHSOURCE

General Provider Information

NPI Number	:	1497754055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOIS S. GOODMAN M.D.

Provider Business Mailing Address
First Line	:	45 COLPITTS RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1546
Country	:	US
Telephone Number	:	781-899-7778
Fax Number	:	781-899-0475

Provider Business Practice Location Address
First Line	:	45 COLPITTS RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1546
Country	:	US
Telephone Number	:	781-899-7778
Fax Number	:	781-899-0475

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

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	09/20/2010

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Directions to “ DR. LOIS S. GOODMAN M.D.” Practice Location

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