Provider Demographics
NPI:1134138860
Name:GOODMAN, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1201 DILWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3205
Mailing Address - Country:US
Mailing Address - Phone:215-947-7588
Mailing Address - Fax:215-441-6946
Practice Address - Street 1:205 NEWTOWN RD
Practice Address - Street 2:STE 213
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-5275
Practice Address - Country:US
Practice Address - Phone:215-674-9133
Practice Address - Fax:215-441-6946
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025395E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology