Provider Demographics
NPI:1487754156
Name:GOODMAN, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01090-1163
Mailing Address - Country:US
Mailing Address - Phone:413-781-1576
Mailing Address - Fax:413-785-1812
Practice Address - Street 1:66 MORGAN RD
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1410
Practice Address - Country:US
Practice Address - Phone:413-781-1576
Practice Address - Fax:413-785-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA447392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2079585Medicaid
MAB99527Medicare UPIN
MA2079585Medicaid