Provider Demographics
NPI:1679579767
Name:GOODMAN, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NEWTOWN RD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-5221
Mailing Address - Country:US
Mailing Address - Phone:215-441-6789
Mailing Address - Fax:215-441-6620
Practice Address - Street 1:225 NEWTOWN RD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-5221
Practice Address - Country:US
Practice Address - Phone:215-441-6789
Practice Address - Fax:215-441-6620
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064018L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014416Medicare PIN