Provider Demographics
NPI:1982601068
Name:GOODMAN, STUART JACK (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JACK
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTERN MARYLAND PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5471
Mailing Address - Country:US
Mailing Address - Phone:301-797-6389
Mailing Address - Fax:301-797-4119
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5471
Practice Address - Country:US
Practice Address - Phone:301-797-6389
Practice Address - Fax:301-797-4119
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD274452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255881OtherJOHNS HOPKINS US FAMILY HEALTH/EHP
MD7419424OtherCIGNA
MD522101237OtherTRISTATE HEALTH PARTNERS
MD798681500Medicaid
MDP01332730OtherRAILROAD MEDICARE
MD522101237OtherPRIME HEALTH SERVICES
MD4051977OtherAETNA
MD522101237OtherHEALTHNET FEDERAL SERVICES
MDW2660036OtherCAREFIRST
MD522101237OtherUNITED HEALTHCARE
MD522101237OtherMARYLAND PHYSICIANS CARE
MD4051977OtherAETNA
MD193363Medicare PIN