Provider Demographics
NPI:1710952536
Name:GOODMAN, ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:GOODMAN
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 146
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-0146
Mailing Address - Country:US
Mailing Address - Phone:814-442-5894
Mailing Address - Fax:
Practice Address - Street 1:1404 HAY ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1455
Practice Address - Country:US
Practice Address - Phone:814-442-5894
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043061L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF25882Medicare UPIN
PA011270Medicare ID - Type Unspecified