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NPI Code Detail

MEDICARE: DR. ROBERT C GODDARD PH.D.

MEDICARE: DR. ROBERT C GODDARD PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist334NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508828237
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT C GODDARD PH.D.
Provider Business Mailing Address
First Line : 66 PROSPECT ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-3506
Country : US
Telephone Number : 603-629-9851
Fax Number :
Provider Business Practice Location Address
First Line : 66 PROSPECT ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-3506
Country : US
Telephone Number : 603-629-9851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 11/16/2013

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