Healthcare Provider Details

I. General information

NPI: 1841227113
Provider Name (Legal Business Name): SANJAY GODARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE SUITE 108
PORTSMOUTH NH
03801-4174
US

IV. Provider business mailing address

330 BORTHWICK AVE SUITE 108
PORTSMOUTH NH
03801-4174
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-4614
  • Fax: 603-436-0377
Mailing address:
  • Phone: 603-436-4614
  • Fax: 603-436-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number017142
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number017142
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number017142
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number17403
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: