Individual
KENNETH A GODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 OXFORD VALLEY RD, SUITE 903, YARDLEY, PA 19067-7706
(267) 399-9930
(267) 399-9931
Mailing address
301 OXFORD VALLEY RD, SUITE 903, YARDLEY, PA 19067-7706
(267) 399-9930
(267) 399-9931
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
OS013816
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
OS013816
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026075430001
—
PA
01
—
2632143
HIGHMARK BLUE SHIELD
PA
01
—
30099393
KEYSTONE MERCY
PA
01
—
3843645000
KEYSTONE IBC
PA
01
—
P00946063
RAILROAD MEDICARE
PA
Enumeration date
10/04/2008
Last updated
06/23/2021
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