Provider Demographics
NPI:1073538740
Name:GOODYEAR, MICHAEL H (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:GOODYEAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-807-8235
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010114L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01756967-03OtherAMERICHOICE - BUCKS
PA07645OtherHEALTH PARTNERS
PA930114018OtherRAILROAD MEDICARE
PA01756967-02OtherAMERICHOICE- TORRES
PA0326345OtherCIGNA
PA0454368000OtherKEYSTONE IBC
PA1096440OtherKEYSTONE MERCY
PA0017569670004Medicaid
PA0017569670006Medicaid
PA01756967-04OtherAMERICHOICE- FRANKFORD
PA20045132OtherAMERIHEALTH MERCY
PA452729OtherAETNA CONTRACT
PA698433OtherPERSONAL CHOICE
PA0017569670005Medicaid
PA698433OtherHIGHMARK BLUE SHIELD
PAH00974Medicare UPIN
PA0017569670006Medicaid