Provider Demographics
NPI:1013213834
Name:DAVID J. GOODKIND, MD, PC
Entity Type:Organization
Organization Name:DAVID J. GOODKIND, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-871-3799
Mailing Address - Street 1:2 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3796
Mailing Address - Country:US
Mailing Address - Phone:203-871-3799
Mailing Address - Fax:203-646-9719
Practice Address - Street 1:2 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3796
Practice Address - Country:US
Practice Address - Phone:203-871-3799
Practice Address - Fax:203-646-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0241792086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001241793Medicaid
CT001241793Medicaid
CT240000048Medicare UPIN