Individual
PAMELA C GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
101507
NC
363AM0700X
Medical Physician Assistant
101507
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7653739
AETNA
—
01
—
C1685
MEDCOST
—
Enumeration date
12/06/2005
Last updated
05/23/2008
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