Provider Demographics
NPI:1114279189
Name:GODWIN, CHLOE ELIZA (MD)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ELIZA
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:GODWIN
Other - Last Name:GORGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14 E 4TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1155
Mailing Address - Country:US
Mailing Address - Phone:212-677-6788
Mailing Address - Fax:646-692-8808
Practice Address - Street 1:14 E 4TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1155
Practice Address - Country:US
Practice Address - Phone:212-677-6788
Practice Address - Fax:646-692-8808
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine