Provider Demographics
NPI:1780632950
Name:GOODMAN, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GOODMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL MS100C
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-6631
Mailing Address - Fax:617-726-1886
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL MS100C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-643-6631
Practice Address - Fax:617-726-1886
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-05-18
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Provider Licenses
StateLicense IDTaxonomies
MA770692080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3133681Medicaid