Provider Demographics
NPI:1942200043
Name:GOODMAN, GERRI L (MD)
Entity Type:Individual
Prefix:DR
First Name:GERRI
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 OLD DERBY ST STE 451
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4062
Mailing Address - Country:US
Mailing Address - Phone:781-534-3804
Mailing Address - Fax:781-749-5853
Practice Address - Street 1:160 OLD DERBY ST STE 451
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4062
Practice Address - Country:US
Practice Address - Phone:781-534-3804
Practice Address - Fax:817-749-5853
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222192207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110075324AMedicaid
J28395OtherBCBS
J28395OtherBCBS
MA110075324AMedicaid