Provider Demographics
NPI:1366872749
Name:GOODMAN, HAROLD DAVID (DO)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:DAVID
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8609 SECOND AVENUE
Mailing Address - Street 2:SUITE 405 B
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3374
Mailing Address - Country:US
Mailing Address - Phone:301-565-2494
Mailing Address - Fax:301-565-2494
Practice Address - Street 1:8609 SECOND AVENUE
Practice Address - Street 2:SUITE 405 B
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3374
Practice Address - Country:US
Practice Address - Phone:301-565-2494
Practice Address - Fax:301-565-2494
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0040143208100000X
ORD020363208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation