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Individual

GAIL R GOODMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3675 SOUTHWESTERN BLVD, ORCHARD PARK, NY 14127-1732
(716) 972-0279
(716) 972-0273
Mailing address
3675 SOUTHWESTERN BLVD, ORCHARD PARK, NY 14127-1732
(716) 972-0279
(716) 972-0273

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
194330
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00010065904
UNIVERA
NY
01
000524370006
BC/BS
NY
05
01477605
NY
01
040426002662
FIDELIS
NY
01
1211151
IHA
NY
01
147716DL
PREFERRED CARE
NY
01
479993
WELLCARE
NY
Enumeration date
01/18/2006
Last updated
08/26/2014
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