Provider Demographics
NPI:1093714024
Name:GOODMAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4140 FERNCREEK DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2563
Mailing Address - Country:US
Mailing Address - Phone:910-485-3880
Mailing Address - Fax:910-485-5341
Practice Address - Street 1:4140 FERNCREEK DR
Practice Address - Street 2:SUITE 601
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2563
Practice Address - Country:US
Practice Address - Phone:910-485-3880
Practice Address - Fax:910-485-5341
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9900510208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891233XMedicaid
NC891233XMedicaid