Provider Demographics
NPI:1740813666
Name:GOUDIE, ERIC (MD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:GOUDIE
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 1:850 RUE SAINT-DENIS
Mailing Address - Street 2:ROOM R04.406
Mailing Address - City:MONTREAL
Mailing Address - State:QC
Mailing Address - Zip Code:H2X 0A9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2021-05-25
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2021-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program