Provider Demographics
NPI:1952378127
Name:GODWIN, LOYD S (MD)
Entity Type:Individual
Prefix:DR
First Name:LOYD
Middle Name:S
Last Name:GODWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORPORATE DR.
Mailing Address - Street 2:SUITE 386
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-538-5682
Mailing Address - Fax:203-538-5685
Practice Address - Street 1:4 CORPORATE DR.
Practice Address - Street 2:SUITE 386
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:00648
Practice Address - Country:US
Practice Address - Phone:203-538-5682
Practice Address - Fax:203-538-5685
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT070000446Medicare ID - Type Unspecified
CTH62871Medicare UPIN