Provider Demographics
NPI:1699762344
Name:GOODMAN, THOMAS L (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-836-3030
Practice Address - Fax:518-836-3020
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2014-02-03
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Provider Licenses
StateLicense IDTaxonomies
NY157963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00846231Medicaid
NY00846231Medicaid
B75805Medicare UPIN