Provider Demographics
NPI:1164054581
Name:GOODESMITH, ANTHONY B
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:GOODESMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2683
Mailing Address - Country:US
Mailing Address - Phone:888-886-1167
Mailing Address - Fax:
Practice Address - Street 1:8815 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2683
Practice Address - Country:US
Practice Address - Phone:888-886-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4213332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1346888666OtherDME