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Individual

DR. MARYELLEN R GOODELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9101 FRANKLIN SQUARE DR, SUITE 205, BALTIMORE, MD 21237-3936
(443) 777-2000
Mailing address
9101 FRANKLIN SQUARE DR, SUITE 205, BALTIMORE, MD 21237-3936
(443) 777-2000

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0066900
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002006261W
HUMANA
05
33345400
WI
Enumeration date
05/20/2006
Last updated
07/07/2010
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