MEDICARE: ROBERT GOODING

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	2085B0100X	Body Imaging Physician	74966	TN

General Provider Information

NPI Number	:	1972458495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GOODING

Provider Business Mailing Address
First Line	:	14625 BALTIMORE AVE STE 344
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4902
Country	:	US
Telephone Number	:	323-591-4871
Fax Number	:

Provider Business Practice Location Address
First Line	:	14625 BALTIMORE AVE STE 344
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4902
Country	:	US
Telephone Number	:	323-591-4871
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ ROBERT GOODING ” Practice Location

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