Provider Demographics
NPI:1508241688
Name:GOODRICH, CYNDI (MPA)
Entity Type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NORTH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4123
Mailing Address - Country:US
Mailing Address - Phone:413-499-8590
Mailing Address - Fax:413-499-6410
Practice Address - Street 1:777 NORTH ST STE 203
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4123
Practice Address - Country:US
Practice Address - Phone:413-499-8590
Practice Address - Fax:413-499-6410
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant