Individual
ELAINE GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13 BREEZY CT, REISTERSTOWN, MD 21136-3532
(410) 902-6540
(410) 902-6071
Mailing address
13 BREEZY CT, REISTERSTOWN, MD 21136-3532
(410) 902-6540
(410) 902-6071
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
R3658
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
521608273
FEDERAL TAX ID #
—
Enumeration date
06/13/2014
Last updated
12/16/2015
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