Provider Demographics
NPI:1912268764
Name:GOODMAN, MARGO B (DO)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:B
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:B
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 MINOT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3924
Mailing Address - Country:US
Mailing Address - Phone:207-795-8475
Mailing Address - Fax:207-795-8490
Practice Address - Street 1:789 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3924
Practice Address - Country:US
Practice Address - Phone:207-795-8475
Practice Address - Fax:207-795-8490
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine