Provider Demographics
NPI:1013929884
Name:GOODMAN, ISAAC (PA-C)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PARK ST
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-6666
Mailing Address - Country:US
Mailing Address - Phone:508-862-5981
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:PHS PROVIDER ENROLLMENT
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INZS11047635M363A00000X
NMPA2016-0053363A00000X
MAPA4312363A00000X
NY010886-1363A00000X
NH2823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ60546Medicare UPIN
NY6079LEX251Medicare ID - Type Unspecified