Provider Demographics
NPI:1417934092
Name:GOODIN, CARL V (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:V
Last Name:GOODIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-533-6001
Practice Address - Street 1:5315 DELHI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5214
Practice Address - Country:US
Practice Address - Phone:513-251-4753
Practice Address - Fax:513-251-4788
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002063213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100093730AMedicaid
OH0484659Medicaid
OH0511812Medicare PIN
IN100093730AMedicaid
IN261450AMedicare PIN
OHT34602Medicare UPIN
480025140Medicare PIN
0694820008Medicare NSC