Provider Demographics
NPI:1528017803
Name:GOODWORTH, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:GOODWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE A-102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-374-4031
Mailing Address - Fax:856-232-9139
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-5650
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080817002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00332777OtherRAILROAD MEDICARE
A3738029OtherOXFORD HEALTH
1396272OtherUNITED HEALTHCARE
1281304OtherAETNA
60025194OtherHORIZON NJ HEALTH
11619019OtherCAQH
NJ0105287Medicaid
GO1869628OtherHIGHMARK PA BLUE SHIELD
272755000OtherAMERIHEALTH
272755000OtherAMERIHEALTH
NJI53083Medicare UPIN