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Individual
MARK TODD GODENICK
Active
Individual
MARK TODD GODENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14616
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4455408
AETNA
SC
01
—
A723893365
MEDICARE PIN
SC
01
—
A723895019
MEDICARE PIN
SC
01
—
AA96196067
MEDICARE PIN
SC
01
—
D6334
MEDCOST
SC
05
—
TL3829
—
SC
Enumeration date
05/18/2006
Last updated
01/12/2021
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