Provider Demographics
NPI:1326386566
Name:DEAN M. GODFREY, DO, LLC
Entity Type:Organization
Organization Name:DEAN M. GODFREY, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-510-4761
Mailing Address - Street 1:PO BOX 7627
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-7627
Mailing Address - Country:US
Mailing Address - Phone:609-510-4761
Mailing Address - Fax:818-889-0517
Practice Address - Street 1:675 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2426
Practice Address - Country:US
Practice Address - Phone:609-510-4761
Practice Address - Fax:818-889-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07600800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI25884Medicare UPIN