Provider Demographics
NPI:1134100738
Name:GODOFSKY, ALAN ARNOLD (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:ARNOLD
Last Name:GODOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:STE 258 ANETHESIA INTENSIVE CARE CONSULTANTS INC
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:7500 STATE RD
Practice Address - Street 2:ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2439
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35 05 3644G207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000077648OtherANTHEM
000000012632OtherANTHEM BLUE SHIELD
10757864OtherCAQH
31 1105593OtherTAX ID
OH0713240Medicaid
IN200377690Medicaid
KY64027980Medicaid
728016OtherBUCKEYE
311585770 1659350494OtherHEALTHNET
10757864OtherCAQH
IN200377690Medicaid
31 1105593OtherTAX ID
OHG07013881Medicare ID - Type Unspecified