Provider Demographics
NPI:1497073563
Name:GODSHALK, ELIHU LAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIHU
Middle Name:LAKE
Last Name:GODSHALK
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 1:3200 VINE ST FL 7
Mailing Address - Street 2:CINCINNATI VA MEDICAL CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2213
Mailing Address - Country:US
Mailing Address - Phone:513-309-6183
Mailing Address - Fax:
Practice Address - Street 1:58 E HOLLISTER ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1704
Practice Address - Country:US
Practice Address - Phone:513-721-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1220292084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry