Provider Demographics
NPI:1194702555
Name:GOODMAN, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-0369
Mailing Address - Country:US
Mailing Address - Phone:978-448-4300
Mailing Address - Fax:978-448-4040
Practice Address - Street 1:100 BOSTON RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1860
Practice Address - Country:US
Practice Address - Phone:978-448-4300
Practice Address - Fax:978-448-4040
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73832207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3077462Medicaid
E84815Medicare UPIN
MA3077462Medicaid