Provider Demographics
NPI:1801661152
Name:MARGO GOODMAN DO PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARGO GOODMAN DO PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-798-5500
Mailing Address - Street 1:11 BOWDOIN MILL IS STE 210
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1241
Mailing Address - Country:US
Mailing Address - Phone:207-798-5500
Mailing Address - Fax:
Practice Address - Street 1:11 BOWDOIN MILL IS STE 210
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1241
Practice Address - Country:US
Practice Address - Phone:207-798-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty