Provider Demographics
NPI:1821031899
Name:GOODKIND, DAVID JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:GOODKIND
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 1:2 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-871-3799
Mailing Address - Fax:203-646-9719
Practice Address - Street 1:2 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-871-3799
Practice Address - Fax:203-646-9719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024179208200000X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001241793Medicaid
CT1241793Medicaid
CT1241793Medicaid
CTA38161Medicare UPIN