Provider Demographics
NPI:1528398518
Name:GOODMAN, CYNTHIA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DIANE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:COVENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:208 W SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4034
Mailing Address - Country:US
Mailing Address - Phone:972-238-1976
Mailing Address - Fax:972-238-0456
Practice Address - Street 1:208 W SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4034
Practice Address - Country:US
Practice Address - Phone:972-238-1976
Practice Address - Fax:972-238-0456
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1640208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016SHOtherBCBS
TXP01005502OtherPALMETTO RR
TX286911701Medicaid
TX8DB165OtherBCBS
TXD07564OtherPALMETTO RR
TXTXB141284Medicare PIN
TX0016SHOtherBCBS
TXTXB128307Medicare PIN
TXD07564OtherPALMETTO RR