Provider Demographics
NPI:1568573293
Name:GODBOLE, MEDHA SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MEDHA
Middle Name:SANJAY
Last Name:GODBOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5301 VIRGINIA WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-695-4977
Mailing Address - Fax:615-263-3348
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-695-4977
Practice Address - Fax:615-263-3348
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-068393207ZP0102X
KYTP277207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10430Medicare UPIN
H10430Medicare UPIN