Provider Demographics
NPI:1457415366
Name:GOODMAN, JESSE LYLE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LYLE
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDSTAR GEORGETOWN UNIVERSITY
Mailing Address - Street 2:3800 RESERVOIR ROAD
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20057-0001
Mailing Address - Country:US
Mailing Address - Phone:202-687-7404
Mailing Address - Fax:
Practice Address - Street 1:WRAMC, BUILDING 2, DEPARTMENT OF MEDICINE
Practice Address - Street 2:6900 GEORGIA AVE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5001
Practice Address - Country:US
Practice Address - Phone:202-782-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034378207RI0200X
MN30,004207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease