Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 227319 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 227319 | MA |
NPI | 1295760262 |
---|---|
Provider Name | Ian S Goodman |
First Address | Springfield, MA 01199-1619 |
Second Address | Springfield, MA 01199-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 11/11/2021 |