Provider Demographics
NPI:1689780074
Name:GOODMAN, MARGARET E (MD)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:E
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 W. LAKE MEAD BLVD.
Mailing Address - Street 2:STE: 250
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7649
Mailing Address - Country:US
Mailing Address - Phone:702-255-8785
Mailing Address - Fax:702-255-8420
Practice Address - Street 1:8551 W LAKE MEAD BLVD
Practice Address - Street 2:STE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7649
Practice Address - Country:US
Practice Address - Phone:702-255-8785
Practice Address - Fax:702-255-8420
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV57472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002521Medicaid
E80430Medicare UPIN
MD5747Medicare ID - Type Unspecified