Provider Demographics
NPI:1396039699
Name:GOODMAN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 ABBY LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4503
Mailing Address - Country:US
Mailing Address - Phone:717-870-0232
Mailing Address - Fax:
Practice Address - Street 1:2572 ABBY LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4503
Practice Address - Country:US
Practice Address - Phone:717-870-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor