Individual
DR. JASON ELLIOTT GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7602 BELAIR ROAD, BALTIMORE, MD 21236
(410) 663-8100
(410) 663-8119
Mailing address
7602 BELAIR ROAD, BALTIMORE, MD 21236
(410) 663-8100
(410) 663-8119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D55846
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4134320-00
—
MD
01
—
613816-01
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
07/13/2006
Last updated
12/14/2009
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