Provider Demographics
NPI:1508837816
Name:GODLEY, FREDERICK AUGUSTUS III (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:AUGUSTUS
Last Name:GODLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:845 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-331-9690
Mailing Address - Fax:401-331-9609
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-331-9690
Practice Address - Fax:401-331-9609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD7590207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7614070OtherAETNA-NON HMO
RI2255578OtherAETNA
RI406139OtherBLUE CHIP OF RI
MA19892OtherHARVARD PILGRIM HEALTH CA
MAJ11772OtherBLUE CROSS BLUE SHIELD
RI10-00234OtherUNITED HEALTH PLAN
RI20996-0OtherBLUE CROSS BLUE SHIELD
RI1594OtherNEIGHBORHOOD HEALTH PLAN
RI5994946001OtherCIGNA
RI406139OtherBLUE CHIP OF RI