Jesse Goodall, MD
Student in an Organized Health Care Education/Training Program in Baltimore, MD. Individual provider (NPI-1).
NPI number1669958286
StatusActive
Last updated in NPPESJul 17, 2018
Details
- NPI
- 1669958286
- Entity type
- Individual (NPI-1)
- Name
- Jesse Goodall
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 17, 2018
- Last updated
- Jul 17, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
2401 W Belvedere AveBaltimore, MD 21215-5216
Phone 410-601-7639
Mailing address
2401 W Belvedere AveBaltimore, MD 21215-5216
Phone 410-601-7639
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