Provider Demographics
NPI:1962606525
Name:GOODMAN, JAMES M (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
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 1:4 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2766
Mailing Address - Country:US
Mailing Address - Phone:978-250-4081
Mailing Address - Fax:978-250-3956
Practice Address - Street 1:4 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2766
Practice Address - Country:US
Practice Address - Phone:978-250-4081
Practice Address - Fax:978-250-3956
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA286780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203145204Medicaid
TX203145203Medicaid
TX203145201Medicaid
TX203145202Medicaid
TXTXB124509Medicare PIN
TX8L15211Medicare PIN
TX203145203Medicaid
TX8L15210Medicare PIN