Provider Demographics
NPI:1447230990
Name:GODSHALL, STANLEY M (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:GODSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:418 CLOVERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9320
Mailing Address - Country:US
Mailing Address - Phone:717-653-1467
Mailing Address - Fax:717-653-1001
Practice Address - Street 1:418 CLOVERLEAF RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9320
Practice Address - Country:US
Practice Address - Phone:717-653-1467
Practice Address - Fax:717-653-1001
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012425E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37441OtherHEALTH ASSURANCE
PA01350202OtherCAPITAL BLUE CROSS
PA127132OtherHIGHMARK BLUE SHIELD
PA17534 S101OtherGEISINGER HEALTH PLAN
PA4662913OtherAETNA NON-HMO
PA577392OtherAETNA HMO
PAP002667OtherGATEWAY HEALTH PLAN
PA0006875700001Medicaid
PA01350202OtherCAPITAL BLUE CROSS
PA127132OtherHIGHMARK BLUE SHIELD