Provider Demographics
NPI:1538059480
Name:GODDARD, BETHANY E (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:E
Last Name:GODDARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BAKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-1125
Mailing Address - Country:US
Mailing Address - Phone:330-415-5713
Mailing Address - Fax:
Practice Address - Street 1:821 BAKER AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-1125
Practice Address - Country:US
Practice Address - Phone:330-415-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant