Provider Demographics
NPI:1720704869
Name:TODD ALAN GOODGLICK, MD, PC
Entity Type:Organization
Organization Name:TODD ALAN GOODGLICK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODGLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-412-9895
Mailing Address - Street 1:3037 ORDWAY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1209
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4301
Practice Address - Country:US
Practice Address - Phone:202-412-9895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty