Individual
DR. MARK J. GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
151 W GALBRAITH RD, CINCINNATI, OH 45216-1015
(513) 948-2707
(513) 948-2698
Mailing address
151 W GALBRAITH RD, CINCINNATI, OH 45216-1015
(513) 416-2484
(513) 418-2698
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35-053722
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012876
ANTHEM
—
05
—
0629743
—
OH
05
—
100351670
—
IN
05
—
64787427
—
KY
Enumeration date
07/03/2006
Last updated
04/07/2021
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