Provider Demographics
NPI:1669460994
Name:GODEFROI, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GODEFROI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8870
Mailing Address - Fax:978-557-8856
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8870
Practice Address - Fax:978-557-8856
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA547742083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA726397OtherTUFTS
MAP00449913OtherRR MEDICARE
MA110066074AMedicaid
MA1669460994OtherFALLON COMMUNITY HEALTH PLAN
NH30201344OtherNH MEDICAID
MA974547OtherNETWORK HEALTH
MAJ04702OtherBLUE CROSS BLUE SHIELD
424231OtherHEALTHSOURCE
MA4572103OtherAETNANON HMO
35256597OtherCIGNA
MA0042049OtherNEIGHBORHOOD HEALTH PLAN
MA1669460994OtherAETNA HMO
MA6197213Medicaid
MA808997OtherHARVARD PILGRIM HEALTHCAR
MA6197213Medicaid
MA110066074AMedicaid