Provider Demographics
NPI:1003924838
Name:GODINE, JOHN ELLIOTT (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELLIOTT
Last Name:GODINE
Suffix:
Gender:M
Credentials:MD PHD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:3RD FLOOR S50 3 DIABETES UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8722
Practice Address - Fax:617-724-8534
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA42546207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0115053Medicaid
MAB33608OtherBCBS
MA712145OtherTUFTS HEALTH PLAN
MA712145OtherTUFTS HEALTH PLAN
MAB33608Medicare ID - Type Unspecified