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Individual

JESSE GODDARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2106 HARRISBURG PIKE STE 310, LANCASTER, PA 17601-2644
(717) 544-5945
(717) 544-5944
Mailing address
2106 HARRISBURG PIKE STE 310, LANCASTER, PA 17601-2644
(717) 544-2644
(717) 544-5944

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD459118
PA
2086S0102X
Surgical Critical Care Physician
Primary
MD459118
PA
2086S0127X
Trauma Surgery Physician
46080
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
103179835
PA
01
PO1804579
RAILROAD MEDICARE
PA
Enumeration date
06/01/2007
Last updated
12/29/2025
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