Provider Demographics
NPI:1922011246
Name:GOODMAN, JESSE ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ADAM
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:38 CHURCH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2525
Mailing Address - Country:US
Mailing Address - Phone:413-637-2300
Mailing Address - Fax:413-315-5276
Practice Address - Street 1:38 CHURCH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2525
Practice Address - Country:US
Practice Address - Phone:413-637-2300
Practice Address - Fax:888-443-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1606252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ26890OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA2299118580OtherUNITED HEALTHCARE
MA2021528Medicaid
MAH94844Medicare UPIN
MAGO A36083Medicare PIN