Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD025394E | PA |
NPI | 1033199856 |
---|---|
Provider Name | Dr. George B Goodman |
First Address | Sewickley, PA 15143-1652 |
Second Address | Sewickley, PA 15143-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0960750 | (05) | PA |
C28230 | (02) | PA |