Provider Demographics
NPI:1841228723
Name:GOGGINS, BERNADETTE ANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ANNE MARIE
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:ANNE MARIE
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64260
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD569932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD756700600Medicaid
MD756700600Medicaid
MDH45148Medicare UPIN