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Provider Information for 1326002817

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

GREGORY GOODWIN M.D.

Gender: MALE

Individual NPI: 1326002817

Calendar   Last Updated:  2011-05-04
  Certification Date: 

Details

Name Value
NPI 1326002817
Enumeration Date 2006-04-13
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 59 MANCHESTER AVE
SOMERSET, MA 02726-4043
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 333 LONGWOOD AVE
BOSTON, MA 02115-5711
United States

Phone: 617-355-7476 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 7007517
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0205X - Pediatrics Pediatric Endocrinology MA 071016