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NPI Code Detail

MEDICARE: JUDY T. GOFFI RD

MEDICARE: JUDY T. GOFFI RD
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
1133VN1006XMetabolic Nutrition Registered DietitianD02101MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F278-0003OTHERCAREFIRST BCBS GHMSI
20981-0121OTHERMDCERT DIABETES ED
3611736-01OTHERCAREFIRST BCBS OF MARYLAN
42431444OTHERUNITED
51145132OTHERAETNA PVN

General Provider Information

NPI Number : 1518950252
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY T. GOFFI RD
Provider Business Mailing Address
First Line : PO BOX 37086
Second Line :
City : BALTIMORE
State : MD
Zip : 21297-3086
Country : US
Telephone Number : 301-714-4041
Fax Number : 301-714-4351
Provider Business Practice Location Address
First Line : 7211 BANK CT
Second Line :
City : FREDERICK
State : MD
Zip : 21703-8483
Country : US
Telephone Number : 240-566-7830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2005
Last Update Date : 06/25/2019

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