Provider Demographics
NPI:1689627200
Name:GOOTMAN, AARON H (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:H
Last Name:GOOTMAN
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:PO BOX 40107
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0107
Mailing Address - Country:US
Mailing Address - Phone:910-223-7246
Mailing Address - Fax:910-223-7247
Practice Address - Street 1:1840 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1633
Practice Address - Country:US
Practice Address - Phone:910-223-7246
Practice Address - Fax:910-223-7247
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132E7Medicaid
NC89132E7Medicaid
NC2005511Medicare ID - Type Unspecified