Provider Demographics
NPI:1669474060
Name:GODSHALL, STEPHEN E
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:GODSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 ERICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8555
Mailing Address - Country:US
Mailing Address - Phone:540-433-3344
Mailing Address - Fax:540-433-0031
Practice Address - Street 1:1751 ERICKSON AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8555
Practice Address - Country:US
Practice Address - Phone:540-433-3344
Practice Address - Fax:540-433-0031
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA278723OtherANTHEM ID#
VA214263OtherSOUTHERN HEALTH ID#
VA278723OtherANTHEM ID#
VA002193R87Medicare ID - Type Unspecified