Healthcare Provider Details

I. General information

NPI: 1841558079
Provider Name (Legal Business Name): ASHLEE NICOLE GODSHALK RUGGLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEE NICOLE GODSHALK B.A.

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 356
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

6560 FANNIN ST STE 1404
HOUSTON TX
77030-2706
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax: 609-537-6002
Mailing address:
  • Phone: 713-790-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10648800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD468677
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR2857
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR2333
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD468677
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA10648800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: