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General NPI Number Information
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NPI Number | 1396819165
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Entity Type | Individual
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Provider Name | REBECCA A GOEDEKE MD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 10200 COPPERMINE RD
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City | WOODSBORO
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State | MD
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Zip | 21798-8319
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Country | US
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Telephone | 301-845-6322
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Fax | 240-578-4480
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Provider Business Mailing Address
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Address Line | 10200 COPPERMINE RD
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City | WOODSBORO
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State | MD
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Zip | 21798-8319
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Country | US
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Telephone | 301-845-6322
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Fax | 240-578-4480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0040223
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License Number State | MD
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