Provider Demographics
NPI:1720977499
Name:GOODMAN, TODD MATTHEW
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MATTHEW
Last Name:GOODMAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64 ECHO RD
Practice Address - Street 2:
Practice Address - City:PENCE SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24962
Practice Address - Country:US
Practice Address - Phone:304-896-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide