Basic Information
Provider Information | |||||||||
NPI: | 1851627129 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GOODRICH-HARRIS | ||||||||
FirstName: | AMY | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GOODRICH | ||||||||
OtherFirstName: | AMY | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 689 | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181051556 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104023110 | ||||||||
FaxNumber: | 6104023112 | ||||||||
Practice Location | |||||||||
Address1: | 1250 S CEDAR CREST BLVD STE 300 | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181036381 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104023110 | ||||||||
FaxNumber: | 6104023112 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/21/2009 | ||||||||
LastUpdateDate: | 06/25/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/25/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0102206211 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 0102206211 | VA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 363A00000X | 0110003527 | VA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363A00000X | MA054044 | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 207RC0000X | OT021163 | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.