Healthcare Provider Details

I. General information

NPI: 1487394359
Provider Name (Legal Business Name): ADAM REINHOLD GODDARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 CLEVELAND ST STE 200
VIRGINIA BEACH VA
23462-1784
US

IV. Provider business mailing address

5716 CLEVELAND ST STE 200
VIRGINIA BEACH VA
23462-1784
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-4802
  • Fax:
Mailing address:
  • Phone: 757-490-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101289140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: