Provider Demographics
NPI:1114288362
Name:GODA, LINNAE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LINNAE
Middle Name:
Last Name:GODA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-721-8795
Mailing Address - Fax:717-336-8284
Practice Address - Street 1:63 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9203
Practice Address - Country:US
Practice Address - Phone:717-721-8795
Practice Address - Fax:717-336-8284
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN00230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA353098FLTMedicare PIN