Provider Demographics
NPI:1922246834
Name:GOEDDEL, LEE ANDREW
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANDREW
Last Name:GOEDDEL
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 1:256 S DURHAM ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2605
Mailing Address - Country:US
Mailing Address - Phone:314-307-4117
Mailing Address - Fax:
Practice Address - Street 1:725 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2105
Practice Address - Country:US
Practice Address - Phone:410-955-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81129207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology