Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | H37405 | MD |
NPI | 1417982208 |
---|---|
Provider Name | Dr. Robert Scott Goodwin |
First Address | Reisterstown, MD 21136-5651 |
Second Address | Baltimore, MD 21224-6823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 26/07/2010 |