Individual
ELIZABETH J GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18901 LAKE SHORE BLVD, EUCLID, OH 44119-1078
(216) 531-9000
Mailing address
PO BOX 74253, CLEVELAND, OH 44194-0002
(440) 879-0081
(440) 879-0084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-000464
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000336118
ANTHEM
OH
01
—
P00113393
RAILROAD MEDICARE
OH
Enumeration date
10/17/2005
Last updated
10/19/2007
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