Provider Demographics
NPI:1932268471
Name:BRUCE A GOODMAN, M.D., P.C.
Entity Type:Organization
Organization Name:BRUCE A GOODMAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-598-3830
Mailing Address - Street 1:790 NEWTOWN YARDLEY RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1748
Mailing Address - Country:US
Mailing Address - Phone:215-860-2424
Mailing Address - Fax:215-860-3044
Practice Address - Street 1:790 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 420
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1748
Practice Address - Country:US
Practice Address - Phone:215-860-2424
Practice Address - Fax:215-860-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039676E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA926337OtherIBC
PA6570340OtherCIGNA
PA0873363001OtherKEYSTONE HEALTH PLAN EAST
PA1196960Medicaid
PA465902OtherAETNA
PA1196960Medicaid
PAE12859Medicare UPIN