Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 0102204153 | VA |
NPI | 1174884589 |
---|---|
Provider Name | Emily J Godbout |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23219-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2012 |
Last Update Date | 18/01/2019 |