Provider Demographics
NPI:1962202291
Name:JEFFREY GOODSELL MD PLLC
Entity type:Organization
Organization Name:JEFFREY GOODSELL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-268-8843
Mailing Address - Street 1:148 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:860-703-7932
Practice Address - Street 1:148 OAK ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2318
Practice Address - Country:US
Practice Address - Phone:434-466-4066
Practice Address - Fax:860-703-7932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY GOODSELL MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty