Provider Demographics
NPI:1205050424
Name:GOODIN, THOMAS ELLIOTT III (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ELLIOTT
Last Name:GOODIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 1ST STREET W
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1620
Mailing Address - Country:US
Mailing Address - Phone:828-466-3000
Mailing Address - Fax:828-464-3281
Practice Address - Street 1:130 1ST ST W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2106
Practice Address - Country:US
Practice Address - Phone:828-466-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15357207L00000X, 207R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936195Medicaid
NC36195OtherBCBS
NC36195OtherBCBS
NC203428FMedicare PIN