Provider Demographics
NPI:1205804804
Name:GOODFRIEND, DAVID PETER (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:GOODFRIEND
Suffix:
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 1:20049 FOREST FARM LN
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3129
Mailing Address - Country:US
Mailing Address - Phone:703-771-5829
Mailing Address - Fax:
Practice Address - Street 1:1 HARRISON ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3102
Practice Address - Country:US
Practice Address - Phone:703-771-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012222602083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine