Basic Information
| Provider Information | |||||||||
| NPI: | 1235113531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODFRIEND | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683130 | ||||||||
| FaxNumber: | 5083683133 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 WORCESTER CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683130 | ||||||||
| FaxNumber: | 5083683133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/05/2009 | ||||||||
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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 | 207RC0000X | 31210 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 2127489 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 441346 | 01 | TUFTS HEALTH PLAN | OTHER | 47644 | 01 | HEALTHY START | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 47644 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | J26791 | 01 | BLUE CARE ELECT | OTHER | 2501884 | 01 | EVERCARE | OTHER | J26791 | 01 | BLUE SHIELD INDEMNITY | OTHER | 2003121 | 05 | MA | MEDICAID | 4270345 | 01 | AETNA US HEALTHCARE | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 3842103 | 01 | CIGNA HEALTH PLAN | OTHER | 67507 | 01 | FALLON COMMUNITY HEALTH | OTHER | 784021 | 01 | MVP HEALTH CARE | OTHER | J26791 | 01 | BLUE SHIELD HMO BLUE | OTHER | AA5962 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER |