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Individual

DR. CHARLES MICHAEL GODDARD II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7275 SAWMILL ROAD, NORTHWEST PEDIATRICS, INC., DUBLIN, OH 43016
(614) 766-6321
(614) 766-0193
Mailing address
7275 SAWMILL ROAD, NORTHWEST PEDIATRICS, INC., DUBLIN, OH 43016
(614) 766-6321
(614) 766-0193

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
059637
MI
208000000X
Pediatrics Physician
Primary
069707
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
059637
MI LICENSE
MI
01
11293017
CAQH PROVIDER ID
MI
05
328339
MI
01
69707
OH LICENSE
OH
Enumeration date
12/15/2006
Last updated
03/07/2023
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