Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 42546 | MA |
N | 111NI0900X | Internist | 42546 | MA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 42546 | MA |
NPI | 1003924838 |
---|---|
Provider Name | Dr. John Elliott Godine |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0115053 | (05) | MA |
712145 | TUFTS HEALTH PLAN (01) | MA |
B33608 | BCBS (01) | MA |
D82763 | (02) |