Provider Demographics
NPI:1508944570
Name:GODIN, WILLIS E (DO)
Entity Type:Individual
Prefix:
First Name:WILLIS
Middle Name:E
Last Name:GODIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:104 PHEASANT RUN STE 128129
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3439
Mailing Address - Country:US
Mailing Address - Phone:215-860-3344
Mailing Address - Fax:215-860-3348
Practice Address - Street 1:104 PHEASANT RUN STE 128-129
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3439
Practice Address - Country:US
Practice Address - Phone:215-860-3344
Practice Address - Fax:215-860-3348
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012471207RC0000X, 207UN0901X
TN3026207RC0000X
VA0102204502207RC0000X
NJMB07505500207RC0000X
NJ25MB07505500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I068217Medicare PIN
VAVVK770AMedicare PIN