Provider Demographics
NPI:1992185011
Name:NEWBY-GOODMAN, MARCIA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:NICOLE
Last Name:NEWBY-GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAJESTIC AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4055
Mailing Address - Country:US
Mailing Address - Phone:757-942-8020
Mailing Address - Fax:757-942-8015
Practice Address - Street 1:930 MAJESTIC AVE STE 220
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-942-8020
Practice Address - Fax:757-942-8015
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129819207Q00000X
FL21807207Q00000X
VA0101266602207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine