Healthcare Provider Details

I. General information

NPI: 1013651884
Provider Name (Legal Business Name): TIMOTHY WILLIAM GODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRONT ST STE 280
CONSHOHOCKEN PA
19428-2891
US

IV. Provider business mailing address

121 FLINTSTONE DR
NORTH EAST MD
21901-2248
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-0100
  • Fax:
Mailing address:
  • Phone: 410-971-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number10273842257
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: