Provider Demographics
NPI:1609135797
Name:GODBOLE, ABHIJIT MORESHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHIJIT
Middle Name:MORESHWAR
Last Name:GODBOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2650
Mailing Address - Country:US
Mailing Address - Phone:870-541-7211
Mailing Address - Fax:870-541-7211
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PINE BUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6301
Practice Address - Country:US
Practice Address - Phone:870-541-3230
Practice Address - Fax:870-541-4297
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-11865207R00000X, 207RH0003X
PAMD455432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine