Individual
ELLIOT GOODENOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1427 VINE ST, PHILADELPHIA, PA 19102-1031
(215) 762-2530
Mailing address
1427 VINE ST FL 4, PHILADELPHIA, PA 19102-1031
(215) 762-2530
(215) 762-2531
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD460791
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103315777
—
PA
Enumeration date
05/30/2015
Last updated
04/16/2020
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