Healthcare Provider Details

I. General information

NPI: 1922014372
Provider Name (Legal Business Name): PETER EDWARD GODFREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 SUNSET LN SUITE 301
CULPEPER VA
22701-3979
US

IV. Provider business mailing address

541 SUNSET LN SUITE 301
CULPEPER VA
22701-3979
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-4557
  • Fax: 540-825-4566
Mailing address:
  • Phone: 540-825-4557
  • Fax: 540-825-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101035487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: