Provider Demographics
NPI:1912314519
Name:GODFREY, MAX (MB BS (LONDON))
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:MB BS (LONDON)
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7 PORTINA RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4618
Mailing Address - Country:US
Mailing Address - Phone:617-834-8325
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BOSTON CHILDREN'S HOSPITAL - CARDIOLOGY DEPT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-834-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2594732080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology