Provider Demographics
NPI:1770361750
Name:GOODELL, CHRISTOPHER EDMUNDSON
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EDMUNDSON
Last Name:GOODELL
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 1:11 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3603
Mailing Address - Country:US
Mailing Address - Phone:800-437-7187
Mailing Address - Fax:
Practice Address - Street 1:11 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3603
Practice Address - Country:US
Practice Address - Phone:800-437-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00000171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications