Provider Demographics
NPI:1326100512
Name:GOODWIN, NANCY G (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:G
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MAINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3310
Mailing Address - Country:US
Mailing Address - Phone:207-725-2429
Mailing Address - Fax:207-721-9345
Practice Address - Street 1:329 MAINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3310
Practice Address - Country:US
Practice Address - Phone:207-725-2429
Practice Address - Fax:207-721-9345
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME264730099Medicaid
MM9181Medicare ID - Type Unspecified
ME264730099Medicaid