Provider Demographics
NPI:1750371217
Name:GOODMAN, MYRON ARTHUR (MD)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:ARTHUR
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MOCKSVILLE AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144
Mailing Address - Country:US
Mailing Address - Phone:704-633-4686
Mailing Address - Fax:704-633-4404
Practice Address - Street 1:601 MOCKSVILLE AVE
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-633-4686
Practice Address - Fax:704-633-4404
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC14667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
36223OtherBCBS
0441034OtherUHC
NC8936223Medicaid
36223OtherBCBS
NC8936223Medicaid