Provider Demographics
NPI:1932135191
Name:GODALE, HEATHER ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ROSE
Last Name:GODALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 MALVERN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1737
Mailing Address - Country:US
Mailing Address - Phone:330-867-2437
Mailing Address - Fax:
Practice Address - Street 1:819 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1003
Practice Address - Country:US
Practice Address - Phone:740-922-2800
Practice Address - Fax:740-922-6945
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086005207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588105Medicaid
OH2588105Medicaid