Provider Demographics
NPI:1134234198
Name:GOODHEART, ALIA (MD)
Entity type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:GOODHEART
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 1:4 GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1100
Mailing Address - Country:US
Mailing Address - Phone:617-650-3324
Mailing Address - Fax:
Practice Address - Street 1:33 NAGOG PARK STE 215
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3427
Practice Address - Country:US
Practice Address - Phone:508-834-3183
Practice Address - Fax:508-532-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2204072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27753OtherBCBS OF MASSACHUSETTS
MA469246OtherTUFTS
MA2063981Medicaid
MA2063981Medicaid