Healthcare Provider Details

I. General information

NPI: 1679701841
Provider Name (Legal Business Name): EMILY SUZANNE GODLEWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N PORTAGE ST
DOYLESTOWN OH
44230-1395
US

IV. Provider business mailing address

80 N PORTAGE ST
DOYLESTOWN OH
44230-1395
US

V. Phone/Fax

Practice location:
  • Phone: 330-658-1550
  • Fax: 330-658-1699
Mailing address:
  • Phone: 330-658-1550
  • Fax: 330-658-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35099640
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: