Provider Demographics
NPI:1346242153
Name:GOODMAN, HENRY C (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:606-329-2823
Mailing Address - Fax:606-324-6291
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-329-2823
Practice Address - Fax:606-324-6291
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY238902084N0400X
OH350455702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439869Medicaid
KY64238900Medicaid
C75277Medicare UPIN
1404901Medicare ID - Type Unspecified
OH0439869Medicaid