Provider Demographics
NPI:1417982208
Name:GOODWIN, ROBERT SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WIND FLOWER CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5651
Mailing Address - Country:US
Mailing Address - Phone:443-740-2526
Mailing Address - Fax:
Practice Address - Street 1:251 BAYVIEW BLVD
Practice Address - Street 2:ROOM 05A727
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6823
Practice Address - Country:US
Practice Address - Phone:443-740-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH37405207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine