MEDICARE: STEPHANIE L GOODWIN DO

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	207RI0011X	Interventional Cardiology Physician	C2-0008116	DE
2	207RC0000X	Cardiovascular Disease Physician	C2-0008116	DE

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	:	1699740738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE L GOODWIN DO

Provider Business Mailing Address
First Line	:	310 TAUGHANNOCK BLVD
Second Line	:	4TH FLOOR
City	:	ITHACA
State	:	NY
Zip	:	14850-3251
Country	:	US
Telephone Number	:	607-269-0100
Fax Number	:	607-269-0140

Provider Business Practice Location Address
First Line	:	310 TAUGHANNOCK BLVD
Second Line	:	4TH FLOOR
City	:	ITHACA
State	:	NY
Zip	:	14850-3251
Country	:	US
Telephone Number	:	607-269-0100
Fax Number	:	607-269-0140

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	10/20/2010

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