Provider Demographics
NPI:1467581561
Name:GOODIE, CHARLES PHILIP (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PHILIP
Last Name:GOODIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4884
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-0084
Mailing Address - Country:US
Mailing Address - Phone:202-291-4581
Mailing Address - Fax:
Practice Address - Street 1:1700 ROCKVILLE PIKE STE 145
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1631
Practice Address - Country:US
Practice Address - Phone:240-221-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004003-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant