Provider Demographics
NPI:1104182120
Name:GODINSKY, LISA CHRISTINE MONTGOMERY (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE MONTGOMERY
Last Name:GODINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:739 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1056
Mailing Address - Country:US
Mailing Address - Phone:330-344-8560
Mailing Address - Fax:330-922-5405
Practice Address - Street 1:739 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1056
Practice Address - Country:US
Practice Address - Phone:330-344-8560
Practice Address - Fax:330-922-5405
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-125855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0122756Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OHH352890Medicare PIN