1518950252 NPI number — JUDY T. GOFFI RD

Table of content: JUDY T. GOFFI RD (NPI 1518950252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518950252 NPI number — JUDY T. GOFFI RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOFFI
Provider First Name:
JUDY
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518950252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37086
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-3086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-714-4041
Provider Business Mailing Address Fax Number:
301-714-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7211 BANK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-8483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-566-7830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  D02101 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F278-0003 . This is a "CAREFIRST BCBS GHMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0981-0121 . This is a "CERT DIABETES ED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 611736-01 . This is a "CAREFIRST BCBS OF MARYLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2431444 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1145132 . This is a "AETNA PVN" identifier . This identifiers is of the category "OTHER".