Provider Demographics
NPI:1376518472
Name:GODSHALL, RICHARD WAMBOLD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAMBOLD
Last Name:GODSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LAWN AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1575
Mailing Address - Country:US
Mailing Address - Phone:215-257-3700
Mailing Address - Fax:215-257-0360
Practice Address - Street 1:711 LAWN AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1575
Practice Address - Country:US
Practice Address - Phone:215-257-3700
Practice Address - Fax:215-257-0360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027221L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0683365Medicaid
016530E3TMedicare ID - Type Unspecified
B32709Medicare UPIN