Provider Demographics
NPI:1629192067
Name:GEORGE B. GOODMAN, M. D., P. C.
Entity Type:Organization
Organization Name:GEORGE B. GOODMAN, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:412-749-4990
Mailing Address - Street 1:701 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1652
Mailing Address - Country:US
Mailing Address - Phone:412-749-4990
Mailing Address - Fax:412-749-4771
Practice Address - Street 1:701 BROAD ST
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1652
Practice Address - Country:US
Practice Address - Phone:412-749-4990
Practice Address - Fax:412-749-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025394E207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA960750Medicaid
PA33578Medicare ID - Type Unspecified
PAC28230Medicare UPIN