MEDICARE: MR. CHARLES DRU GOODWIN MD

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	2086S0120X	Pediatric Surgery Physician	35040957	OH
2	208600000X	Surgery Physician	35040957	OH

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	:	1922107978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES DRU GOODWIN MD

Provider Business Mailing Address
First Line	:	500 E MAIN ST
Second Line	:	STE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5369
Country	:	US
Telephone Number	:	614-321-3701
Fax Number	:	614-259-6072

Provider Business Practice Location Address
First Line	:	500 E MAIN ST
Second Line	:	STE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5369
Country	:	US
Telephone Number	:	614-321-3701
Fax Number	:	614-259-6072

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/17/2017

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Directions to “ MR. CHARLES DRU GOODWIN MD” Practice Location

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