Provider Demographics
NPI:1659334852
Name:GOODMAN, VALERIE ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELLEN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-296-7190
Mailing Address - Fax:443-991-7768
Practice Address - Street 1:2540 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2681
Practice Address - Country:US
Practice Address - Phone:410-758-4432
Practice Address - Fax:410-758-1938
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDH57821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25969Medicare UPIN
H25969Medicare UPIN