Provider Demographics
NPI:1760259667
Name:ALLISON GODDARD, M.D., LLC
Entity Type:Organization
Organization Name:ALLISON GODDARD, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-510-7068
Mailing Address - Street 1:66 LEIGHTON RD # 2
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2225
Mailing Address - Country:US
Mailing Address - Phone:207-305-4196
Mailing Address - Fax:207-360-4214
Practice Address - Street 1:66 LEIGHTON RD # 2
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2225
Practice Address - Country:US
Practice Address - Phone:207-305-4196
Practice Address - Fax:207-360-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty