Provider Demographics
NPI:1053489435
Name:GODWIN, MARTIN DANIEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DANIEL
Last Name:GODWIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 COOMER RD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9613
Mailing Address - Country:US
Mailing Address - Phone:716-778-0230
Mailing Address - Fax:
Practice Address - Street 1:534 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1436
Practice Address - Country:US
Practice Address - Phone:585-798-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349871-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered