Provider Demographics
NPI:1770466799
Name:GOODLEY, MARVIN D
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:D
Last Name:GOODLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2549
Mailing Address - Country:US
Mailing Address - Phone:240-476-5598
Mailing Address - Fax:301-248-2937
Practice Address - Street 1:1819 BAY RIDGE AVE STE 190
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2834
Practice Address - Country:US
Practice Address - Phone:443-281-9430
Practice Address - Fax:443-782-2446
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program