Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101250341 | VA |
N | 207PP0204X | Pediatric Emergency Physician | 31432 | TN |
Y | 2080P0204X | Pediatric Emergency Doctor | 0101250341 | VA |
NPI | 1427058114 |
---|---|
Provider Name | Dr. Sandip A Godambe |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G96395 | (02) | TN |