Provider Demographics
NPI:1003296914
Name:GOODSELL, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GOODSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2318
Mailing Address - Country:US
Mailing Address - Phone:860-351-7401
Mailing Address - Fax:833-973-6047
Practice Address - Street 1:148 OAK ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2318
Practice Address - Country:US
Practice Address - Phone:860-351-7401
Practice Address - Fax:833-973-6047
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209559207Q00000X
CT61787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine