Provider Demographics
NPI:1740209196
Name:GOODFELLOW, DONALD B (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:GOODFELLOW
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 1:20800 HARVARD RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 S GREEN RD STE 27
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-844-7200
Practice Address - Fax:216-291-3984
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042252207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512869Medicaid
OH363569OtherWELLCARE
OH738055OtherBUCKEYE
OHP00011035OtherRAILROAD MEDICARE
OHP00385113OtherRAILROAD MEDICARE
OH000000206624OtherUNISON
000000503676OtherANTHEM
4007304OtherAETNA
OH738055OtherBUCKEYE
000000503676OtherANTHEM
OHGO0528359Medicare PIN