Provider Demographics
NPI:1417374653
Name:GOODWIN, ALEXANDRA MEDITCH CAMPBELL
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MEDITCH CAMPBELL
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVENUE
Mailing Address - Street 2:BELLEVUE HOSPITAL AMB CARE DESK 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2909
Mailing Address - Country:US
Mailing Address - Phone:212-562-5555
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVENUE
Practice Address - Street 2:BELLEVUE HOSPITAL AMB CARE DESK 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2909
Practice Address - Country:US
Practice Address - Phone:212-562-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY294208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program