Provider Demographics
NPI:1952354581
Name:BISKUP-GODFREY, CHARLOTTE L (MA)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:L
Last Name:BISKUP-GODFREY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:L
Other - Last Name:BISKUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3455 WILKENS AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5213
Mailing Address - Country:US
Mailing Address - Phone:410-646-3100
Mailing Address - Fax:410-646-3102
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:410-646-3100
Practice Address - Fax:410-646-3102
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00443231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150L000BMedicare ID - Type Unspecified