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NPI Code Detail

MEDICARE: CHERYL GODDARD CRNP

MEDICARE: CHERYL GODDARD CRNP
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
1363LF0000XFamily Nurse PractitionerR087591MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
164769601OTHERMDCAREFIRST BC OF MD IND #
20119OTHERDCCAREFIRST BC OF NCA IND #

General Provider Information

NPI Number : 1942278510
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL GODDARD CRNP
Provider Business Mailing Address
First Line : 1067 UPNOR RD
Second Line :
City : BALTIMORE
State : MD
Zip : 21212-4021
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9109 LIBERTY RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-3521
Country : US
Telephone Number : 410-655-7373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 12/21/2025

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