Healthcare Provider Details

I. General information

NPI: 1902900335
Provider Name (Legal Business Name): KAMAR GODDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S.W. 62ND AVENUE, SUITE #121 NORTH EAST WING
MIAMI FL
33155
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD.
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8360
  • Fax: 305-666-6387
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237615
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number0101237615
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME117214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: