Provider Demographics
NPI:1962505578
Name:ROBERT C GOODMAN DPM PC
Entity Type:Organization
Organization Name:ROBERT C GOODMAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:978-744-4904
Mailing Address - Street 1:10 COLONIAL RD STE 8
Mailing Address - Street 2:COLONIAL OFFICE PARK
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2947
Mailing Address - Country:US
Mailing Address - Phone:978-744-4904
Mailing Address - Fax:978-744-2589
Practice Address - Street 1:10 COLONIAL RD STE 8
Practice Address - Street 2:COLONIAL OFFICE PARK
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2947
Practice Address - Country:US
Practice Address - Phone:978-744-4904
Practice Address - Fax:978-744-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1635213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9753753Medicaid
T58720Medicare UPIN
R0Y77116Medicare ID - Type Unspecified