Basic Information
| Provider Information | |||||||||
| NPI: | 1013929884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODMAN | ||||||||
| FirstName: | ISAAC | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 PARK ST | ||||||||
| Address2: | PHS PROVIDER ENROLLMENT | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026016666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088625981 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27 PARK ST | ||||||||
| Address2: | PHS PROVIDER ENROLLMENT | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088625981 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | ZS11047635M | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA4312 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 010886-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA2016-0053 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.