Provider Demographics
NPI:1447278429
Name:GOODMAN, CYNTHIA M (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1240 S ELISEO DR
Mailing Address - Street 2:STE 201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2028
Mailing Address - Country:US
Mailing Address - Phone:415-925-8555
Mailing Address - Fax:415-925-4082
Practice Address - Street 1:1240 S ELISEO DR
Practice Address - Street 2:STE 201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2028
Practice Address - Country:US
Practice Address - Phone:415-925-8555
Practice Address - Fax:415-925-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73359208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A733590Medicaid
CAH47730Medicare UPIN
CA00A733590Medicaid