MEDICARE: KELLY GOODMAN NP & ASSOCIATES PC

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	363LF0000X	Family Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner	R156558	MD
3	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1740503689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY GOODMAN NP & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	4701 SANGAMORE ROAD
Second Line	:	SUITE S207
City	:	BETHESDA
State	:	MD
Zip	:	20816-2529
Country	:	US
Telephone Number	:	202-684-7167
Fax Number	:	240-483-0441

Provider Business Practice Location Address
First Line	:	4701 SANGAMORE ROAD
Second Line	:	SUITE S207
City	:	BETHESDA
State	:	MD
Zip	:	20816-2529
Country	:	US
Telephone Number	:	202-684-7167
Fax Number	:	240-483-0441

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY ANN GOODMAN
Credential	:	NP
Telephone Number	:	202-684-7167

Provider Enumeration Date	:	03/07/2010
Last Update Date	:	07/14/2025

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