Provider Demographics
NPI:1922107978
Name:GOODWIN, CHARLES DRU (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DRU
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5369
Mailing Address - Country:US
Mailing Address - Phone:614-321-3701
Mailing Address - Fax:614-259-6072
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-321-3701
Practice Address - Fax:614-259-6072
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350409572086S0120X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336121Medicaid