Provider Demographics
NPI:1891790762
Name:GOODWIN, ERIC H (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
Last Name:GOODWIN
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 1:44 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5118
Mailing Address - Country:US
Mailing Address - Phone:716-649-1495
Mailing Address - Fax:
Practice Address - Street 1:229 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4915
Practice Address - Country:US
Practice Address - Phone:716-649-1342
Practice Address - Fax:716-649-3909
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855725Medicaid
NY00855725Medicaid
NYAA0500Medicare ID - Type Unspecified