Provider Demographics
NPI:1235113531
Name:GOODFRIEND, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GOODFRIEND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-3130
Mailing Address - Fax:508-368-3133
Practice Address - Street 1:20 WORCESTER CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-368-3130
Practice Address - Fax:508-368-3133
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA31210207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
2127489OtherFIRST HEALTH
042472266OtherTHREE RIVERS
441346OtherTUFTS HEALTH PLAN
47644OtherHEALTHY START
042472266OtherONE HEALTH PLAN
47644OtherCHILDRENS MEDICAL SECURIT
J26791OtherBLUE CARE ELECT
2501884OtherEVERCARE
J26791OtherBLUE SHIELD INDEMNITY
MA2003121Medicaid
4270345OtherAETNA US HEALTHCARE
042472266OtherUNITED HEALTHCARE
3842103OtherCIGNA HEALTH PLAN
67507OtherFALLON COMMUNITY HEALTH
784021OtherMVP HEALTH CARE
J26791OtherBLUE SHIELD HMO BLUE
AA5962OtherHARVARD PILGRIM HEALTHCAR
3842103OtherCIGNA HEALTH PLAN
B77907Medicare UPIN