Provider Demographics
NPI:1386686525
Name:GOODMAN, CHAD JAMES (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JAMES
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-925-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA718682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A718680Medicaid
CA300121754OtherRAILROAD MEDICARE
CA00A718680OtherBLUE SHIELD OF CA
CA00A718689Medicare PIN
CA00A718680OtherBLUE SHIELD OF CA
CABU339YMedicare PIN
CA300121754OtherRAILROAD MEDICARE
CABU339SMedicare PIN
CABU339UMedicare PIN
CA00A7186813Medicare PIN
CA00A7186810Medicare PIN
CA00A718680Medicaid
CA00A718684Medicare PIN
CABU339WMedicare PIN
CA00A718680Medicare PIN
CA00A7186811Medicare PIN
CAG69215Medicare UPIN
CA00A718688Medicare PIN
CABU339XMedicare PIN